In our last blog we summarized the prior authorization (PA) reform experience in the United States, including the role of the 2018 American Consensus Statement, which was developed through a collaboration between several healthcare associations. The Statement identified opportunities to improve the PA experience.
One of the five areas of improvement identified in the Statement was in payer Transparency and Communication. This was based on the belief that with effective communication channels between stakeholders PA claims can be submitted with the complete information necessary for payers to make a decision as early as possible in the process. To facilitate this, the Statement recommended the following be in place:
Transparency, or clarity, from payers on the PA workflow process is beneficial for several reasons:
The Workplace Safety and Insurance Board (WSIB) in Ontario, offers an example of what transparency can look like to prescribers and their patients in Canada. The WSIB site lists what prescribers must include in the application for a prior authorization drug, including but not limited to the rationale for requesting the drug, dose and duration of treatment, laboratory results, and supporting literature. Canadian private payers may choose not to make this level of detail readily available. However providing a thorough list of requirements for claims evaluation can provide clarity to other stakeholders that will reduce frustration, and improve the timeliness and efficiency of the process, avoiding lengthy delays for additional or outstanding information.
All stakeholders in the private benefit landscape in Canada would benefit from common industry workflow standards. According to the Standards Council of Canada, a standard is document that provides a set of agreed-upon rules, guidelines or characteristics for activities or their results. Standards can establish accepted practices, and have benefits not only to protect consumers, but also by promoting competitiveness and facilitating innovation.
(Reference: https://www.scc.ca/en/standards/what-are-standards)
The Best Practice Standards for Prior Authorization in Canada are now in development, led by the Simplify Prior Authorization initiative, and supported by a diverse group of stakeholders.
Thank you to Gold sponsors of the SPA initiative Amgen and Gilead, plus Silver sponsors AstraZeneca and Cencora/Innomar Strategies.
Look out for the next in our blog series on Canada vs U.S. prior authorization trends, an update on the development of the first Canadian Prior Authorization Best Practice Standards, and upcoming webinars on developments in prior authorization for your industry sector.
Stakeholders with an interest in prior authorization are invited to reach out to SPA to contribute to the development of these Guidelines.
If you would like to know more about this initiative, are interested in getting involved or sponsoring this initiative, please contact Denise Balch at info@simplifypriorauth.ca.
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.
In this third in our six-part series on prior authorization (PA) in Canada vs the U.S. we address the selective application of PA.
Since 2020, the conversation around improving the prior authorization process and experience has been gaining traction in Canada. 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.
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.
