My insurance company requires a prior authorization before they will cover the cost of my medication. What does that mean?
It means that the insurance company requires additional, special information before they will cover the cost of your medication. The insurance company wants to know that certain criteria have been met before they will pay for certain, usually more expensive, medications. It may mean that the insurance company prefers that you try and fail a lower cost alternative first; it may mean that they want more information on your medical condition to see that the medication is being used appropriately. For some medications, the insurance company requires a prior authorization annually for as long as the medication is in use. When a prior authorization is required, the pharmacy faxes the request to a nurse at our office. She consults with the provider, and then she gathers the necessary clinical information. She documents the information and the request for coverage and then she faxes it to the insurance company. The insurance company usually responds within three working days. They will notify
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