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Person stamping an application as approved
Person stamping an application as approved

Significant Grant Awarded for Development of Electronic Prior Authorization in Canada

On Monday, June 17, 2024, the Canadian Medical Association (CMA) Foundation, Scotiabank, and MD Financial Group, announced GreenShield and OkRx, a technology solutions provider, have been awarded a grant of close to one million dollars from over two hundred grant applicants. The grant will be used for the launch of electronic prior authorization (ePA) in Canada, including integration with electronic medical records (EMRs).

According to the CMA website, ‘The goal is to reduce physician administrative burden and improve patient outcomes through faster access to medication and therapy. The first therapeutic focus [is] on rheumatology, with a longer-term goal of scaling to all conditions and private insurers.’

‘We are grateful for this grant and CMA’s recognition of the administrative burden prior authorization forms place on physicians. This innovative technology will usher in a new standard for prior authorization processing in Canada and significantly reduce that burden, allowing doctors to dedicate more time to their patients.’
– Ramy El-Kholi, Chief Commercial Officer, OkRx

Physicians and their patients are those most impacted by the administration in the current paper-based prior authorization (PA) claims process. This is particularly true in the case of rheumatology and oncology. However, although repeated efforts have been made to engage group insurers, they have largely been unwilling to consider minimum administration standards and new electronic solutions to improve the efficiency of the PA process, including reducing their own administrative burden.

The announcement of this grant is the ideal next step in physician support for reform and will allow GreenShield and OkRx to lead the insurance industry in fundamental change to the PA process. Engagement by other insurers is sure to follow.

More information about the impact of the current PA process and opportunities for change, including physicians concerns with the PA process, were documented in the original 2020 Report on Private Payer Prior Authorization in Canada: Simplify Prior Authorization. Physicians have since continued their call for reform in podcasts, webinars, articles, and blogs from the Simplify Prior Authorization (SPA) initiative and have provided input to the Prior Authorization Framework and Accreditation Program (PAFAP) launching in Fall 2024.

For more information about prior authorization and changes to the process, contact info@simplifypriorauth.ca.


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