Specialty Drugs and Prior Authorization: Challenges and Solutions – Summer Webinar 2022

On June 22, 2022, the Simplify Prior Authorization (SPA) initiative hosted the third 2022 webinar, this time with insurers, pharmacy benefit managers, and patient support programs as our target audience. The webinar explored the current prior authorization (PA) process in the private and public sector, the progress towards a viable electronic prior authorization (ePA) solution to improve the process and a new online education resource for stakeholders currently under development. Find out about other sessions in this series for patient groups (April 19, 2022) and advisors and plan sponsors (May 3, 2022). You can view our blog on these sessions here to find out more.

Presenters at each of the three webinars included Rachael Manion, Executive Director of Canadian Skin Patient Alliance & Canadian Association of Psoriasis Patients, Alan Birch, Associate Director of Provider Solutions – Oncology with Sentrex and founder of Drug Access Canada, and Denise Balch, President of Connex Health. At the June 22nd session we were also joined by John Leombruno, President and CEO, and Ramy El-Kholi, Chief Commercial Officer at OkRx also presented on the innovative OkRx ePA solution. You can can view the full webinar recording here.

Prior authorization involves a time-consuming manual claims process that can involve numerous stakeholders prior to submission to a payer for reimbursement. This can include the patient, physician, patient support professionals and sometimes a drug access navigator. As a result, patients can be left waiting weeks before they can start treatment, and this can have a significant impact on patient outcomes. Recently there has been significant improvement in the public sector process through the implementation of Special Authorization Digital Information Exchange (SADIE), an electronic online submission tool which can process claims within 1-2 business days. The private sector has yet to see the implementation of this kind of innovation.

The SPA initiative and its partners are advocating for improvements in the PA process. We believe this can happen with the adoption of an agnostic and seamless, electronic process for reimbursement of PA claims. This would be beneficial to patients and those stakeholders that assist them with the claims process and create efficiencies for payers. It would not change the reimbursement decision, or the criteria used to determine who qualifies for reimbursement.

Polling during the June webinar told us there is interest in the SPA initiative and efficiencies in prior authorization. Almost three quarters of attendees thought the prior authorization process/experience could be improved. When we asked attendees why they were motivated to register for the webinar:

  • /68% wanted to learn what work is being done to deliver new process efficiencies in prior authorization
  • /66% wanted to hear how the claim and reimbursement process for specialty drugs can be improved
  • /57% wanted to learn more about the existing prior authorization reimbursement process for specialty drugs and the challenges of current PA
  • /38% wanted to learn about what an ePA is and what it looks like.

Full polling results from the June 22nd session can be found here.

There were two major themes from the attendee evaluation results in terms of takeaways:

  • 1 Inefficiencies in the PA process: “The current system is a mess”, “it [current PA process] is not working”, “still using faxes”, “healthcare is still very manual, and paper-based”, “we are in an archaic world that is having huge impacts on patient care”, “PA entails various stakeholders”, “too many steps on the private side”
  • 2 Interest in ePA: “OkRx’s platform and integration is SOOOOO exciting to view, even from an insurer’s perspective”, “smart PDF and the OkRx difference”, “OkRx is an amazing solution”, “very cool solution by OkRx”, “role of automation in PA forms”. This (ePA) solution will benefit all parties involved.

Thank you to everyone who joined us at these webinars. The feedback from participants in these webinars reinforces the interest among stakeholders in improving the PA process and in the need to provide additional online resources where stakeholders can access information and education on PA.

Look for updates to the progress of the OkRx ePA solution, the adoption of ePA, and the launch of the new stakeholder online education and resource site. We will be hosting an SPA webinar in Fall 2022.

For more information on the Simplify Prior Authorization initiative you can contact Denise Balch at Connex Health denisebalch@connexhc.com.

Blogs

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.

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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.

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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.

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