As we prepare to announce details of a new phase of prior authorization for specialty drug claims later this summer, now is a good time to recap our journey as well as next steps.
Since 2020, the Simplify Prior Authorization initiative has worked collaboratively with industry stakeholders to address the recommendations of The 2020 Report on Prior Payer Prior Authorization in Canada and be a catalyst for change in prior authorization (PA). The recommendations of the Report called for addressing the challenges of PA through a multi-stakeholder collaboration to:
In response, the Simplify Prior Authorization (SPA) initiative formed in Fall 2020 has created blogs, podcasts, and articles to raise awareness of the need for changes to the PA claims process and to provide evidence to support change. A library of blogs, podcasts, and articles can be found on this website, which also provides a unique information source for all stakeholders, including patients. Since 2020 SPA has been active on social media, including LinkedIn, and in early 2024, we launched a new patient focussed Facebook campaign.
In addition to the online campaign, SPA has hosted webinars for industry stakeholders, and project manager Denise Balch has spoken at events on prior authorization to a range of stakeholders including advisors, patient groups, payers, pharmacy and pharmaceutical manufacturers.
Some of SPA’s highlights since 2020 have included:
There have been several developments in the Canadian public and public prior/special authorization space since 2020:
Look for more details of The Prior Authorization Framework and Accreditation (PAFA) Program, and our new PAFA website and PAFA Program Guide launch in early Fall 2024.
For information on how to become a PAFA member or associate member and how to get involved in the Advisory Board and Accreditation Panel, please contact denisebalch@connexhc.com.
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 blog, we focus on the important role of Drug Review Committees in maintaining a responsive and sustainable PA process through a regular review of existing medications as well as reviewing new medications that may be subject to prior authorization.
The interest in prior authorization is growing, which is driving more interest in reforming current practices and policies to become more efficient and drive down administration costs and reduce the time-consuming claims process.
Navigate the prior authorization (PA) process in Canada can be time consuming and confusing. Inefficiencies in the system create real challenges for all stakeholders—physicians, pharmacists, insurers, advisors, and most importantly, patients.
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.