The Simplify Prior Authorization (SPA) initiative was formed in 2021 to advocate for improvements in the claims process for prescription drugs that require prior or special authorization (PA) by payers, usually insurers, before reimbursement is approved.
This website is a resource for all stakeholders involved in the prior authorization (PA) process. Everyone should find some useful information about the process, tips on navigating prior authorization, and answers frequently asked questions. You can also learn about electronic prior authorization (ePA) and why it will be an easier and more efficient claims process for patients and everyone in the circle of care, including physicians, payers and pharmacy.
In current prior authorization (PA) practices private payers (insurers or pharmacy benefit managers (PBMs)) reimburse a prescribed medication on the condition of satisfactory medical evidence from a patient and their prescriber according to criteria established by payers.
The current prior authorization landscape has many challenges including the administrative and financial burden of the process. In a fully electronic prior authorization (ePA) process claims are made and adjudicated online. This is a goal for the future but not practical for first generation ePA in Canada. On this site you will find more details on current prior authorization practices and what can be implemented now as a first generation ePA solution in Canada to ease the current burden on prior authorization stakeholders.
Podcast Featuring a conversation between Denise Balch, President, Connex Health and Rachael Manion, Executive Director, Canadian Skin Patient Alliance (CSPA). A lawyer
On June 22, 2022, the Simplify Prior Authorization (SPA) initiative hosted the third 2022 webinar, this time with insurers, pharmacy benefit managers, and patient support programs as our target audience.
Podcast Featuring a conversation between Denise Balch, President, Connex Health and Dr. Neil Shear, recently retired Dermatologist and Professor Emeritus, Temerty Faculty