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The prior authorization process for specialty drugs is here to stay. Public and private payers are challenged to manage limited drug budgets and will therefore continue to manage access for specialty drugs. The claims process for specialty drugs has improved in some provinces with the introduction of electronic claims preparation and submission. This has created a more efficient process for all stakeholders in the claims process, including patients.
From a prescriber’s perspective an electronic prior authorization (ePA) solution will solve many of the logistical challenges you face in today’s prior authorization environment and create efficiencies that will benefit you and your patients.
Currently each payer creates their own unique claim forms for the prior authorization process that must be completed and signed by both prescribers and patients. Criteria and what needs to be included on claim forms can also differ between payers.
Payers may also require copies of patients’ medical records for their review. An ePA solution will mean that all the required information and documentation, including signatures, will be entered, or collected electronically, through one system.
You will be able to offer your patients an improved prior authorization claims experience and you and patient support programs (PSPs) or drug access navigators (DANs) in the case of cancer drugs, will be able to help patients access their prescribed medication more quickly than through the current paper/fax-based process.
The private sector has not moved to an electronic claims preparation and submission process – yet. However, a move to electronic prior authorization is gaining support among private payers. The Simplify Prior Authorization initiative, including this website, is one organization that is advocating for the adoption of an electronic prior authorization process by private payers and is working with a network of other providers and supporting organizations to create opportunities for payers to adopt electronic prior authorization. You can find out more about electronic prior authorization in Canada in the ePA section of this website.
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.
