Welcome to our April 2026 update on electronic Prior Authorization (ePA)! This section describes the current prior authorization process, how it could be improved, and gives you up to date information on electronic prior authorization.
In electronic prior authorization, the preparation, submission, and adjudication of claims are made online. This is the way claims are processed for non-specialty drugs that do not require prior authorization. In a fully ePA environment:
While some drugs requiring prior authorization, like GLP-1s, may be available from a patient’s local pharmacy, and patients may have a similar pharmacy experience as for other medications, other specialty medications will only be avialable through a limited number of community pharmacies or specialty pharmacies because of storage or administration requirements.
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.