Your health insurance carrier may require a prior authorization due to a combination of factors including:
- high cost of the medication
- availability of less expensive alternative medications
- Medications limited to treat specific health conditions.
To obtain a prior authorization, your provider (or representatives from your provider’s office) must contact your insurance company and attest to the appropriateness of the medication for your medical needs. This often includes submitting documentation of your medical condition(s), prior medications that you have tried, and any relevant safety considerations. Your insurance carrier reviews the request and may approve, deny, or follow up with your provider for more details. Please note that an approval from your insurance company may still involve a copay for the medication.
Prior authorizations may also be referred to as pre-authorizations, precertifications, or prior approvals.
See the following FAQ's for more information: