What is a prior authorization?
Prior Authorization is a process to ensure that certain drugs are prescribed appropriately for specific conditions. It is not required for all drugs. It only affects a small number of medications, which require Prior Authorization to be covered. Prior Authorization is essential for both medical and financial reasons. Medically, it acts as a safeguard against drugs that can be: Harmful – such as certain medications prescribed in combination Ineffective – like using a growth hormone in someone when no additional bone growth is expected Misused – such as some acne medications that can be used for other cosmetic purposes It also guarantees that health care dollars are used for drugs that are medically necessary, so that the right drug gets to the right person at the right cost for the right duration. Decisions about prior authorization are made with guidelines developed by physicians. If you are concerned about which medications may require a prior authorization, contact your prescription
