After the release of a comprehensive report on Private Payer Prior Authorization in Canada in Fall 2020, the Simplify Prior Authorization (SPA) initiative was created to advocate for improvements in the prior authorization (PA) claims process. Since then, SPA has shared new insights into PA and explored the many opportunities for improvement through multiple media.
The SPA initiative has also been instrumental in fostering a made-in-Canada electronic prior authorization (ePA) solution, and will continue to support opportunities to drive improvements in PA. Look for our announcement and webinar coming soon on a new tool that will help stakeholders evaluate PA processes.
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.
Changes in prior authorization are now coming to the U.S. at the federal level. What does this mean for Canada?
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