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Working Towards New Solutions in Prior Authorization

Did you follow the Simplify Prior Authorization (SPA) initiative in the first half of 2021 after the release of the white paper on prior authorization (PA) in November 2020? The white paper included a summary of the opportunities and challenges for PA stakeholders and included recommendations to improve the PA process and the patient experience. You may have already seen some of the SPA external communications that have been part of this initiative, but there has been more happening than just talk, and there is plenty more activity to come this fall.

To add to the white paper findings we’ve produced three blog articles on PA from the perspective of insurers and pharmacy benefit managers, the prescribing physicians, and of course on patients. We’ve also recorded podcasts with those familiar with the PA process, two of which we recorded in June and in July. In June we talked with Dr. Mark Vincent, medical oncologist at the London Regional Cancer centre, and in July, with Dr. Imtiaz Khan, rheumatologist in Mississauga and Chair of the Ontario Rheumatologists Association Private Payers Committee. We discussed the experiences and challenges they, their patients, and colleagues face in navigating the current PA process, and they provided insights on how to improve it.

Since the white paper’s release, we’ve been working with our sponsors, a new steering committee and working groups to help create a better understanding of the challenges of PA and work towards a better process for patients and other PA stakeholders. We haven’t finished yet. In the coming months you’ll see articles from us in Benefits and Pensions Monitor and Insights magazines, more blogs and podcasts. Plus, we’ll keep you informed as we develop new tools and solutions to improve the PA claims process and deliver new resources to PA stakeholders.

Simplify Prior Authorization is a collaborative initiative that welcomes additional sponsors and those with expertise who are willing to work together to support and contribute to improvements in the prior authorization process and environment.

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

You can direct questions, comments and inquiries to Denise Balch, Connex Health Consulting denisebalch@connexhc.com or email info@simplifypriorauth.ca

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 and the Impact on Physicians

During research for the Simplify Prior Authorization (SPA) white paper in 2020, we learned how the prior authorization (PA) workflow process was impacting prescribers. We heard that there are several areas that make current PA processes challenging for physicians in delivering care to their 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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