Do you represent a private payer, such as an insurer or pharmacy benefit manager (PBM)? If so, you may be familiar with your organization’s role in the prior authorization process, a process that can be unique to each insurer, including claims criteria for approval. Those stakeholders who aren’t familiar with the process, like patients, and even advisors, can benefit from some extra help.
The Simplify Prior Authorization website was developed to provide information for all prior authorization stakeholders, even insurers and PBMs. The I am an Insurer or PBM tab of the site was specifically developed with payers in mind. It provides insights into the experiences of other stakeholders and suggestions for some simple common-sense improvements in the process.
The I am an Insurer or PBM tab includes four sections:
There is more! You will see additional sources under the Resources tab of this site. You may find some useful links for your use, or sometimes you may decide to direct plan members to this tab or the Patient or Patient Group tab when there are questions about the resources and information that is available, or about the process.
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.
What’s next? We are working on recommended best practices for prior authorization. Stay tuned!
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.
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.
