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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. In a fully electronic prior authorization (ePA) process claims are made and adjudicated online. 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.
“The SPA website has been a great resource for me to share with new professionals in the industry as a way of providing them a comprehensive 101 of the Prior Authorization landscape, its stakeholders, and their common challenges.”
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.
Since 2020, the conversation around improving the prior authorization process and experience has been gaining traction in Canada. However, there has been much more than discussion in the U.S. Learn what Canadian stakeholders can take away from American developments.
Are you a physician, pharmacist, or other prescriber that has patients with a prescription for specialty medications? If you are, it’s likely that your patients have a prescription for a therapy or medication that requires prior authorization, and they probably have questions about it.
Do you represent a patient support/assistance program (PSP/PAP)? If you do, it’s likely that the patients you help have a prescription for a therapy or medication that requires prior authorization, and they probably have questions about it.
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.
