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The First Prior Authorization Resource for Plan Sponsors or Advisors

Are you a plan sponsor or advisor? Do your plan members have claims for specialty drugs?

If so, it’s likely that plan members have questions regarding the prior authorization process, a process common for the reimbursement of specialty drugs. The complexities of the prior authorization process can be difficult to navigate for both plan sponsors/advisors, and plan members as insurers requirements, forms, and submission processes may vary.

The Simplify Prior Authorization website was developed to provide information for plan sponsors and advisors, and other stakeholders on private payer prior authorization in a context that would be relevant to their experience.

The I am a Plan Sponsor tab includes four sections:

  1. When Is a Prescription Drug a Specialty Drug?
  2. Why is the Prior Authorization Designation Used?
  3. Prior Authorization Stakeholders, You. and the Prior Authorization Claims Process
  4. When A Claim Has Been Denied

As well as the website content, a PDF is available for each of the I am a Plan Sponsor or Advisor sections. The Simplify Prior Authorization website and PDFs meet accessibility standards. The website and most content is available in English and French.

Plan sponsors and advisors can also find additional sources of assistance under the Resources tab of this site, that may be useful to direct plan members to.

For more information on prior authorization, other aspects of the Simplify Prior Authorization initiative, or how to get involved or support the website, contact Denise Balch at info@simplifypriorauth.ca.

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Our LinkedIn Page provides useful resources and information related to Prior Authorization with resources available for patients, benefits and healthcare stakeholders, follow our LinkedIn Page to stay up to date.

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