07 Oct Prior Authorizations: Let’s Get Your Medication Approved
Your doctor recently prescribed a new medication for you. However, when you show up to the pharmacy to pick up your medication, the pharmacist says your insurance requires a prior authorization before they will pay for it. What is a prior authorization and what happens next?
A prior authorization, sometimes referred to as a preauthorization, is a process used by insurance companies to ensure certain medications are being prescribed appropriately. This process is required before the insurance company will agree to pay for the medication. Prior authorizations are generally required for more expensive brand name medications, medications that may have a cheaper and equally effective alternative, and medications that are often misused or abused.
The pharmacy or patient can contact the prescriber to notify them of the prior authorization requirement. The prescriber can either change the prescription to an effective alternative that your insurance plan will cover or start the prior authorization. The prescriber can complete the prior authorization by submitting documentation to the insurance company and the insurance company will determine if the medication is appropriate. The prior authorization approval/denial process can take as little as 3 days and may sometimes take up to 2 weeks.
At CaryRx, we know this process can be stressful and we try to make the it as easy as possible. We will let you know through our app if your medication requires a prior authorization and will send an electronic request to your doctor’s office. We will also work with your doctor’s office to find the right alternative medication just for you. If the prior authorization is approved or if we get an alternative prescription, you will be notified by us and then you will be able to confirm your order and schedule delivery.