Summary of what researchers found:

  • 1Stakeholders* subject to the process would benefit from greater consistency in the workflow process between payers.
  • 2More transparency and consistency in claim forms would improve the PA process.
  • 3Stakeholders would benefit from changes to the current paper-based claims process to reduce the administrative burden.
  • 4There is an opportunity to improve the consistency of the review and appeals process between payers.
  • 5Patients on PA drugs would benefit from industry grandfathering standards to prevent loss of coverage on transfer of carriers.
  • 6Payer metrics and stakeholder evaluations would identify opportunities to improve the PA workflow process.

Blogs

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.

read more...

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.

read more...

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.

read more...