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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.
Contact the SPA team with any questions, comments, to find out more, get involved, or for sponsorship of this important initiative. Plus you can register to receive upcoming blogs, podcasts, and for notification about upcoming webinars.
Blog The Simplify Prior Authorization (SPA) initiative recently hosted its first webinar in 2023 for group benefits stakeholders on new prior authorization
Featuring a conversation between Denise Balch, President, Connex Health and Rachael Manion, Executive Director, Canadian Skin Patient Alliance (CSPA).
Featuring a conversation between Denise Balch, President, Connex Health and Dr. Neil Shear, recently retired Dermatologist and Professor Emeritus, Temerty Faculty of Medicine: Dermatology, Clinical Pharmacology & Toxicology.
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The Simplify Prior Authorization initiative is an advocate for education about prior authorization (PA) and improvement in current prior authorization practices and processes. If your organization is interested in finding out more, getting involved, or in sponsorship of this important initiative, please contact us via the link below.
