Do you represent a private payer, such as an insurer or pharmacy benefit manager (PBM)? If so, you may be familiar with your organization’s role in the prior authorization process, a process that can be unique to each insurer, including claims criteria for approval.
Are you a plan sponsor or advisor? Do your plan members have claims for specialty drugs? If so, it’s likely that plan members have questions regarding the prior authorization process, a process common for the reimbursement of specialty drugs
Read our new article in the May edition of the Benefits and Pension Monitor magazine, where we explore the history of prior authorization, specialty drug spend, new technologies and solutions to advance prior authorization.
Do you or your clients have specialty drug claims on group benefit plans? If so, you need to read this blog and find out about the new patient information and resources website.
The Simplify Prior Authorization (SPA) initiative recently hosted its first webinar in 2023 for group benefits stakeholders on new prior authorization (PA) resources and solutions. Interest was high, with the largest registration numbers since the initiative began.
On April 19th and May 3rd, 2022, the Simplify Prior Authorization (SPA) initiative hosted webinars for patient groups and advisors/plan sponsors on the Challenges and New Solutions in the Private Prior Authorization Landscape.
Canadians with cancer have been experiencing longer times to diagnosis and medical treatment during the pandemic. A backlog has been building that will take years to address, according to Dr Tony Eskander, surgical oncologist of the mouth, throat and neck at Sunnybrook Health Sciences Centre in Toronto.
Since the release of the Simplify Prior Authorization white paper, we’ve been working with our sponsors, a new steering committee and working groups to help create a better understanding of the challenges of prior authorization and work towards a better process for patients and other stakeholders.
Prior authorization is typically used by insurers as a manual claim submission and review process for high-cost speciality or high-utilization prescription drugs.
During research for the Simplify Prior Authorization (SPA) white paper in 2020, we learned how the prior authorization (PA) workflow process was impacting prescribers.