Consulting Dr.Review

Prior Authorization – The Future for Insurers and PBMs

Find out more about the role of insurers and pharmacy benefit managers (PBMs), payers, in the prior authorization (PA) process in this article.

In previous SPA blogs and podcasts, we have addressed patient and physician perspectives on the current group benefit private PA process, sometimes called special authorization.

PA is typically used by insurers as a manual claim submission and review process for high-cost speciality or high utilization prescription drugs. Stakeholders involved in the PA process report that the administrative burden of the current manual PA process is time consuming and inefficient, delaying patient access to prescribed medication.

The PA process is growing increasingly complex. The list of drugs is growing, each payer has their own claim forms for PA, and there is no coordinated workflow process for payers and PA stakeholders. Provincial health ministries are moving online, and it is overdue for private payers to do the same.

The Simplify Prior Authorization (SPA) initiative was launched in November 2020 following the release of the white paper on prior authorization by Connex Health and the Pangaea Group. The initiative is committed to developing ePA and other solutions that will improve the access process for patients and the user experience for PA stakeholders, including payers. SPA has attracted some payers and many other PA stakeholders who are willing to work collaboratively on an agnostic industry solution to improve the process.

Find out what this initiative is undertaking and why now is the right time for action in our full article on Prior Authorization – The Future for Insurers and PBMs.

We can and we must do better. When we do, we all benefit.

You can direct questions, comments and inquiries as follows:

Denise Balch, Connex Health Consulting

Or email


Microsite Launch

In November 2020 the Simplify Prior Authorization white paper was introduced at the Benefits Breakfast Club and the Prior Authorization Q&A Blog was developed to respond to questions and clarify important issues like payer autonomy, funding of the initiative and the benefits of simplifying the current prior authorization process.


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.


Prior Authorization Q&A – What You Need to Know

On the November 26, 2020 Benefits Breakfast Club webinar experts addressed innovations in oncology and the role of prior authorization (PA), including the many challenges of a largely paper-based PA process.