Creating an accelerated process in specialty drug benefits

by Leo Almazora25 Nov 2020

While the COVID-19 pandemic has brought nearly aspect of physical activity to a virtual standstill, it has pushed entire industries to accelerate their adoption of digital technologies. In Canada’s healthcare space, insurers have become more motivated than ever to support policyholders and claims applicants with virtual healthcare and simplified underwriting.

That push toward electronic processing has extended into the world of benefits. TELUS Health, Canada Life, and Innomar Strategies recently announced a collaborative pilot program to launch Canada’s first electronic drug prior authorization (ePA) solution.

“We’ve been thinking about it for quite a time,” said Ryan Weiss, vice president, Group Customer Product and Experience for Canada Life. “There's a better-established ePA industry and solutions in the U.S. market, and we were looking there for a number of years to see how we could leverage that in Canada.”

But as Weiss explained, the U.S. model has been on Canada Life’s radar for a long time, and it was only a matter of time before Canada Life would adopt it in Canada. “COVID-19 really served to accelerate our work with TELUS Health to test the accuracy and effectiveness of ePA over the traditionally paper-based prior authorization process. It was very important for us to push this forward and start some of the work now to make sure this great service can be brought to more sponsors and customers,” he said.

A new and improved ePA process could very well prove vital in the years to come. The current prior authorization process, which ensures a benefits plan member is approved to receive coverage for certain prescription medications, requires considerable coordination between benefits plan sponsor and members, insurance providers and payors, and healthcare providers. Depending on factors such as the complexity of the case and occurrence of errors, that can prove cumbersome and time-consuming.

Aside from reducing the need for in-person contacts, an electronic process can provide a lot of opportunities to improve the process for plan sponsors, members, and healthcare providers. The faster that prior authorization can be processed, the faster serious conditions can be addressed, which can lead to better health outcomes for members and decreased strain for medical professionals. An improved experience among stakeholders is also in the best interests of insurance companies, as it would reduce inquiries to call centres as well as enable a faster and more efficient adjudication process.

“The pilot or proof of concept really is meant to test out the technology and make sure that everything runs smoothly,” he said. “We're starting with a small number of drugs, focusing mainly on patient support programs, and we're going to make sure everything works.”

Through the TELUS Health ePA solution, physicians and patient support staff can access a web portal and initiate the prior authorization process. Once there, they can complete the necessary forms – which include pre-populated information and user prompts – secure electronic signatures, and deliver digital outputs directly to insurance providers and payors.

“We were uniquely positioned to develop the new ePA solution as the largest health IT company in the country, with more than a decade of experience delivering innovative digital health and health benefits tools and services,” said Jason Kennedy, director, Health Business Consulting, TELUS Health.

Aside from TELUS Health’s world-class network and proven expertise in enabling more efficient communication within Canada’s health system, Kennedy highlighted the company’s long history of cooperation and partnership with Canada Life. “With their input, as well as that of Innomar Strategies, we are well on our way to making the TELUS Health ePA solution as robust and well-rounded as possible,” he said.

There’s no reason to expect that the ePA solution will yield anything other than a faster process, better controls, and cleaner data. But Weiss said Canada Life and its partners in the initiative aim to do much-needed “fine tuning” based on the results of the pilot program. Depending on how it turns out, they may elect to make changes such as introducing more checks, making parts of the process more intuitive, or streamlining some of the questions.

“We're excited to be first in the market with this because we know it's something that customers and sponsors have been asking for a long time,” he said. “I think it just underscores our commitment to investments in technology and improving the experience of customers, doctors, members, and the whole continuum of stakeholders we work with.”