What Drugs Require Prior Authorization?

Why do some drugs require prior authorization?

Prior authorization for prescription drugs is required when your insurance company asks your physician to get specific medications approved by the insurance company.

Prior authorization must be provided before the insurance company will provide full (or any) coverage for those medications.

What medical procedures require prior authorization?

Prior authorization (PA) is any process by which physicians and other health care providers must obtain advance approval from a health plan before a specific procedure, service, device, supply or medication is delivered to the patient to qualify for payment coverage.

Who obtains prior authorization?

A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

How long does a prior authorization last?

Your insurer will then decide whether or not to cover your medicine, and you should hear back from your pharmacist about their decision within two days. Remember, if you are approved, a prior authorization only lasts for a set period of time, and you will likely have to re-apply again for future fills.