What is a Prior Authorization?

With so many drugs out there that don’t have a generic you’re bound to hear us to tell you one day, “I’m sorry but this medication requires a prior authorization.” Then the burning question. What’s a prior authorization? It’s simple; it means that your insurance will not cover the drug the doctor has written for you unless the provider provides details explaining why you need that particular medication. There may be specific criteria that must be met such as symptom severity or even trying other medications first.

When you bring us a prescription that requires a prior authorization we immediately send your doctor’s office the specific form that your insurance company requires. Many physician offices have a person on staff designated to complete these requests and that person will have to access your chart to complete the required paperwork and have the doctor approve it. Once the form is completed and returned to the insurance company, they have a few days to either approve or deny the request. If after several days we don’t have an answer from your insurer, we may suggest that you give your doctor a call to be sure they have communicated with your insurance company.

Prior authorizations are a frustrating but common issue in pharmacy. As insurers try to cut costs, they put more restrictions on the medications they will cover. Next time you bring in a new prescription and you hear us tell you that it requires a prior authorization we can work together to get you your medicine quicker.

Ana Araguz, CPhT
Certified Pharmacy Technician