Researchers Recommendations:

  • 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.

Blogs

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.

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Prior Authorization: The Impact On Patients

During research for the Simplify Prior Authorization (SPA) white paper in 2020, we learned how the prior authorization (PA) process was impacting patients.

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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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