In this podcast Ramy El-Kholi, Chief Commercial Officer with OkRx joins Denise Balch to provide an update on the development of electronic prior authorization (ePA) and its implementation in Canada. They will explore how the definition of electronic prior authorization for specialty and high volume drugs is evolving, how electronic medical records will be implemented, and why there is growing interest in implementation of ePA in the group benefits industry.

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Visit our website here:
https://www.simplifypriorauth.ca/

If you would like to know more about the Simplify Prior Authorization initiative, are interested in getting involved or sponsoring this initiative, please contact Denise Balch at [email protected].

Our LinkedIn Page provides useful resources and information related to Prior Authorization with resources available for patients, benefits and healthcare stakeholders. Follow our LinkedIn Page to stay up to date.

In this episode of the Simplify Prior Authorization podcast series Denise Balch once again speaks to Dr. Imtiaz Khan, a licensed rheumatologist in Canada and the U.S. Dr. Khan is the former Head of Rheumatology at The Mississauga Hospital and is now in private practice and continues to be active in clinical research. Dr. Khan became Chair of the Ontario Rheumatologists Association (ORA) Private Payers committee in 2019.

Dr. Khan shares his insights into how new developments in the treatment of rheumatoid arthritis are changing patient treatment, including the introduction of biosimilars and new small molecules taken orally known as Janus kinase (JAK) inhibitors. He speaks to the efficiencies the electronic specialty authorization claims process for public payers in Ontario (SADIE) has created, and opportunities for the private sector to benefit from electronic prior authorization to ease the administrative burden and patient wait times without compromising drug cost management.

Featuring Alan Birch, the Associate Director of Provider Solutions at Sentrex and Founder of Drug Access Canada.

In this podcast, Alan shares with Denise Balch, Project Manager of Simplify Prior Authorization, why improving access points to reimbursement and the reimbursement process is critical to improving time to treatment and ultimately patient outcomes.

You can find more about Drug Access Canada at www.drugaccess.ca and Simplify Prior Authorization, including Alan’s recent blog, at www.simplifypriorauth.ca.

Look for our upcoming announcement on industry standards for prior authorization and more blogs and podcasts in 2024.

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Our LinkedIn Page provides useful resources and information related to Prior Authorization with resources available for patients, benefits and healthcare stakeholders, follow our LinkedIn Page to stay up to date.

Featuring a conversation with Shanta Zurock, Director of Reimbursement with Innomar Strategies.

Denise Balch, Project Manager, Simplify Prior Authorization, speaks with Shanta about the evolution of prior authorization programs and some of the key challenges in the prior authorization journey for patients and payers. Shanta will also share insights into the challenges of multi stakeholder collaboration and consensus when considering changes to improve prior authorization. They will also explore the SPA agenda and the benefits of using digital technology to improve the process.
 
Shanta has an extensive knowledge of the healthcare, insurance and drug environment in Canada, including reimbursement issues. Prior to joining Innomar, she was a senior professional in the pharmaceutical environment, and has spent time as a clinical pharmacist, insurance drug plan manager, and pharmaceutical market access professional. She has an extensive knowledge of the healthcare, insurance and drug environment in Canada.

Featuring a conversation with Gavin Mosley, CEBS and Denise Balch, Project Manager, Simplify Prior Authorization and President, Connex Health. Gavin is a benefits consultant who operates his own boutique benefits brokerage and his InsurTech company The GroupBenefitz Platform, in Ottawa, Ontario. Gavin holds his CEBS designation and sits on the board of the Ottawa Region Rewards Association and volunteers in schools as part of the Social Entrepreneurs Program, where children are taught how to run socially responsible businesses.

In this podcast Gavin Mosley and Denise Balch speak about the conversations Gavin has had with his clients about specialty drugs and prior authorization, and the support he has provided to plan members through the process.  Based on these experiences, Gavin will share his insights into the challenges of the current paper based claims process and the opportunity to improve it for everyone’s benefit.

You can find out more in our article on Why It’s Time To Change The Prior Authorization Process in the May 2023 edition of Benefits and Pensions Monitor. You can also find a copy of the original Simplify Prior Authorization white paper and links to our articles, podcasts and blogs at the new website for all PA stakeholders - www.simplifypriorauth.ca.

Want to stay connected?

Our LinkedIn Page provides useful resources and information related to Prior Authorization with resources available for patients, benefits and healthcare stakeholders, follow our LinkedIn Page to stay up to date.

Find out more information about Simplify Prior Authorization at www.simplifypriorauth.ca.

Featuring a conversation between Denise Balch, President, Connex Health and Rachael Manion, Executive Director, Canadian Skin Patient Alliance (CSPA). A lawyer by training Rachael has spent time with 3Sixty Public Affairs as a Senior Associate and Director of Research, and Legal Counsel at the Department of Justice, Government of Canada.

In this podcast Rachael Manion and Denise Balch will speak about Rachael’s dedication to patients, and the challenges of timely access to medications for patients and the impact of prior authorization requirements. Her exposure to patient experiences has led the CSPA’s development of an interactive drug coverage finder Is My Prescription Covered. She has also been active on the working group of the Simplify Prior Authorization (SPA) initiative and the development of the new online stakeholder resource launching later this month.

Listen and learn from Rachael Manion how what more can be done to improve the patient experience when they are prescribed a drug requiring prior authorization.

You can find a copy of the original Simplify Prior Authorization white paper and links to our articles, podcasts and blogs at www.simplifypriorauth.ca.

Featuring a conversation between Denise Balch, President, Connex Health and Dr. Neil Shear, recently retired Dermatologist and Professor Emeritus, Temerty Faculty of Medicine: Dermatology, Clinical Pharmacology & Toxicology. Before his retirement in 2021, Dr. Shear held several appointments at University of Toronto, Sunnybrook and Women’s College Hospital in Toronto. In retirement he continues to teach and consult, including on data monitoring committees (DMC), whose focus is examining drug safety for those drugs in development and those on the market.

In this podcast Dr. Neil Shear and Denise Balch will speak about the advances of dermatology as a profession and in the available treatments for dermatology patients. They explore some of the complex and debilitating dermatological diseases that can lead to mental health issues, withdrawal from society, and an inability to work if not treated effectively. They also discuss treatment progression protocols and the impact of newer treatments that are prescribed for patients who do not respond well to traditional therapies. Some of these treatments are accompanied by reimbursement challenges as a result of the prior authorization process which both dermatologists and patients must navigate to gain access.

If you missed one of our recent webinars for patient groups, advisors, or plan sponsors you can join our June 22, 2022 webinar for insurers and patient support programs. Find out more and register here.

You can also find a copy of the original Simplify Prior Authorization white paper and links to our articles, podcasts and blogs at www.simplifypriorauth.ca.

Featuring a conversation between Denise Balch, President, Connex Health and Ramy El-Kholi, Pharm.D., Chief Commercial Officer, OkRx. Ramy has held diverse roles in both Canada and the U.S. including patient support programs, specialty pharmacy start ups, pharmacy benefits management and digital health.

In this podcast Ramy El-Kholi and Denise Balch will speak about the logistics of the prior authorization (PA) process for specialty drugs and the complexities of the process which result in a significant administrative burden to PA stakeholders. Ramy will also explain how the process can be improved by creating administrative efficiencies through technology.

Want to learn more about prior authorization? For context you can listen to our last podcast with Alan Birch, the Associate Director, Provider Solutions – Oncology with Sentrex and founder of Drug Access Canada. In The Rough Road to Navigating Drug Access in Canada we discuss the reimbursement and approval process for patients who are prescribed specialty drugs that require prior authorization, the reimbursement gaps, and barriers to access. We also explore how the landscape is changing.

You can also see our November article in Benefits and Pensions Monitor.

Find out more information about Simplify Prior Authorization at www.simplifypriorauth.ca.

Featuring a conversation between Denise Balch, President, Connex Health and Alan Birch, the Associate Director, Provider Solutions – Oncology with Sentrex. Alan is also the founder of Drug Access Canada.

In this podcast Denise and Alan will speak about the reimbursement and approval process for patients who are prescribed specialty drugs that require prior authorization, the reimbursement gaps, and barriers to access. They will also explore how the landscape is changing. With more drugs expected to require prior authorization by insurers, new tools are required to cope with the administrative burden, a burden that is largely unknown to advisors and plan sponsors.

Here is a link to Drug Access Canada that Alan refers to in the podcast, plus links to two books Alan recommends to anyone working in benefits and reimbursement:

1. Patients at Risk – Exposing Canada’s Healthcare Crisis by Susan Martinuk
2. Being Mortal: Medicine and What Matters in the End by Atul Gawande

Find out more information about Simplify Prior Authorization at www.simplifypriorauth.ca.

Featuring a conversation with Dr. Imtiaz Khan, Rheumatologist, practicing in Mississauga and Chair of the Ontario Rheumatologists Association Private Payers Committee. 

This fourth podcast in our dedicated prior authorization (PA) series includes an engaging discussion with Dr. Khan about his experiences with PA in the private sector. He will share the burden of forms and paperwork for both public and private systems, the support received from patient support programs (PSPs), and how the private payer PA process could be improved.

If you are not sure why private payer prior authorization processes need to become more efficient, then we recommend that you listen to this podcast and look out for our communications over the coming weeks and months. You can also find the PA white paper, articles and podcasts at www.simplifypriorauth.ca.

Recorded June 9, 2021.