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

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 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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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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