Simplify Prior Authorization
A multi-stakeholder initiative led by Connex Health Consulting.
The goal of this initiative is to create an industry solution to the challenges of prior authorization (PA) programs*.
This microsite has been developed to provide information on the Simplify Prior Authorization initiative to all stakeholders in the PA process and those with an interest in PA.
*Sometimes called special authorization programs.
The White Paper on Prior Authorization
Summary of what researchers found:
- 1Stakeholders* subject to the process would benefit from greater consistency in the workflow process between payers.
- 2More transparency and consistency in claim forms would improve the PA process.
- 3Stakeholders would benefit from changes to the current paper-based claims process to reduce the administrative burden.
- 4There is an opportunity to improve the consistency of the review and appeals process between payers.
- 5Patients on PA drugs would benefit from industry grandfathering standards to prevent loss of coverage on transfer of carriers.
- 6Payer metrics and stakeholder evaluations would identify opportunities to improve the PA workflow process.
*Stakeholders include physicians, pharmacists, patient navigators, benefit advisors and plan sponsors/employers.
- 1Create a web portal for all stakeholders with:
- /On-line electronic claims process for PA claims (ePA)
- /A repository of clinical evidence for payers
- /Lists of PA drugs by payer
- /Claim forms for PA drugs.
- 2Improve transparency and create standardization in the workflow process.
- 3Provide clear avenues within payers for appeal.
- 4Develop industry grandfathering standards for PA.
- 5Identify common metrics and reporting for payers as well as evaluations for physicians, patients and patient navigators.
- 6Management by an independent agency.
The Plan to Simplify Prior Authorization
It isn’t easy to create industry-level change, especially when there many stakeholders involved, so we’re tackling it in a multi-phased process with the participation of numerous experts:
The white paper report on Private Payer Prior Authorization.
The Steering Committee and working groups will respond to the recommendations of the white paper.
The first pilots will go live and preparation will be finalized for full market launch.
Want to know more?
View our infographic for how we are creating change in prior authorization practices.
Featuring a conversation between Denise Balch, President, Connex Health and Ramy El-Kholi, Pharm.D., Chief Commercial Officer, OkRx. Ramy has held diverse roles in both Canada and the U.S. including patient support programs, specialty pharmacy start ups, pharmacy benefits management and digital health.
The Need for Administrative Efficiencies in Prior Authorization
Challenges and New Solutions in the Prior Authorization Landscape
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.read more...
Addressing the Backlog of Cancer Patients
Canadians with cancer have been experiencing longer times to diagnosis and medical treatment during the pandemic.read more...
How to Support Simplify Prior Authorization
We are building our financial support through sponsorship of this multi-stakeholder initiative. We also welcome contributions of time and expertise. To receive a copy of our sponsorship package contact us.
For More Information Contact
- Gilead Sciences Canada, Inc.
Get In Touch
If you have questions, are interested in finding out more about this initiative or providing support, please contact us.