Prior authorization is a process used by health insurance companies to review certain medications before they are covered by the plan. The goal is to ensure that the medication is medically necessary and appropriate for the patients situation. Prior authorization is required for some medications, and it is important to check if a medication needs prior authorization by logging in to your account at your insurance companys website or by looking at your plans drug list.
The prior authorization process involves the prescriber receiving pre-approval for prescribing a particular drug in order for that medication to qualify for coverage under the terms of the pharmacy benefit plan. The prescriber must justify the therapeutic basis for the prescribed medication. The process gives the prescriber the opportunity to explain why the medication is necessary and appropriate for the patients situation.
It is important to note that prior authorization is an approval of coverage from the insurance company, not the doctor. It is a restriction put in place to determine whether or not the insurance company will pay for certain medicines. Prior authorization does not affect cash payment for prescriptions, and it is only required on those prescriptions when billed through insurance.
In summary, prior authorization is a process used by health insurance companies to review certain medications before they are covered by the plan. The goal is to ensure that the medication is medically necessary and appropriate for the patients situation. Prior authorization is required for some medications, and it is important to check if a medication needs prior authorization by logging in to your account at your insurance companys website or by looking at your plans drug list. The prior authorization process involves the prescriber receiving pre-approval for prescribing a particular drug in order for that medication to qualify for coverage under the terms of the pharmacy benefit plan.
