Advancements in medical research have yielded innovative medications in recent years and can significantly improve the lives of those living with migraine. Migraines can leave individuals grappling with excruciating pain, sensitivity to light and sound, nausea, and a host of other distressing symptoms. These episodic neurological events affect millions of people worldwide, with an estimated 12% – equivalent to 4.5 million Canadians – affected by migraine.
New therapies for migraine are often subject to prior authorization, which is currently a paper-based and time-consuming process, including submitting claims by mail or fax to payers, insurers or pharmacy benefits managers. Once the claim has been through the prior authorization process and is approved, the approval will be reviewed at a future date. The claim may be approved again or renewed or it may be denied on review. As part of the payer’s evaluation for renewal in the case of migraine, patients are required to report their monthly migraine days. The payer will use this information to evaluate whether the medication has been effective.
Today’s paper-based prior authorization process is time consuming for payers and other stakeholders. It also means patients often wait longer than necessary for access to their medication, but that’s not all. Collecting and combining data across a group of patients for evaluating aggregate health outcomes is valuable to payers, but very time-consuming with a paper-based process. When payers do collect aggregate outcomes data, they can use it for evaluating prior authorization criteria and for negotiating outcome-based agreements.
Finding an efficient way to collect reliable patient outcomes data is important for payers and for manufacturers. The absence of a reliable and efficient way to collect aggregate patient outcomes data means outcomes-based product listing agreements are rare. Electronic prior authorization (ePA) not only reduces the administration burden of prior authorization on all stakeholders, it promises to be a missing link in developing outcomes-based agreements.
The ongoing digitization of healthcare and the adoption of an electronic prior authorization process offers promising opportunities. By leveraging technology and electronic platforms, ePA can help both patients and payers benefit from a more efficient administrative process and so much more.
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.
