Consulting Dr. Review

Prior Authorization – The Future for Insurers and Pharmacy Benefit Managers (PBMs)

In previous SPA blogs and podcasts, we have addressed patient and physician perspectives on the current group benefit private PA process, sometimes called special authorization.

PA is typically used by insurers as a manual claim submission and review process for high-cost speciality or high-utilization prescription drugs. Stakeholders involved in the PA process report that the administrative burden of the current manual PA process is time consuming and inefficient, delaying patient access to prescribed medication.

The PA process is growing increasingly complex. The list of drugs is growing, each payer has their own claim forms for PA, and there is no coordinated workflow process for payers and PA stakeholders. Provincial health ministries are moving online, and it is overdue for private payers to do the same.

The Simplify Prior Authorization (SPA) initiative was launched in November 2020 following the release of the white paper on prior authorization by Connex Health and the Pangaea Group. The initiative is committed to developing electronic prior authorization (ePA) and other solutions that will improve the access process for patients and the user experience for PA stakeholders, including payers. SPA has attracted some payers and many other PA stakeholders who are willing to work collaboratively on an agnostic industry solution to improve the process.

We can and we must do better. When we do, we all benefit.

You can direct questions, comments and inquiries to

Related Blogs