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A woman sharing her issues in a patient support program.
A woman sharing her issues in a patient support program.

The First Prior Authorization Resource for Patient Support Programs

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 complexities of the prior authorization can be difficult to navigate for patients, as well as those who may aide patients through the prior authorization process, including patient support programs. Insurers requirements, forms, and submission processes may vary, and therefore can be difficult to complete.

The Simplify Prior Authorization website was developed to provide information for PSPs, as well as other stakeholders in the PA process on private payer prior authorization in a context that would be relevant to their experience. The PSP section outlines a comprehensive background on prior authorization, including how to complete the process, from finding claim forms, to submitting claims and appeals, and much more.

The I am a Patient Support Program tab includes seven sections:

  1. Patient Support/Assistance Program (PSP) and Prior Authorization
  2. Why is the Prior Authorization Designation Used? 
  3. How Do I Know if the Medication the Patient has been Prescribed Requires Prior Authorization?
  4. Insurers and Pharmacy Benefits Managers (Payers) and Their Role
  5. The Claims Process
  6. What to do if the Claim is Denied?
  7. The Future of Prior Authorization

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

PSP representatives can also find additional sources of assistance under the Resources tab of this site, that may be useful to direct patients 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.

Want to stay connected?

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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