Preferred Drug Program FAQs All Member FAQs Why are prior authorizations required on certain drugs?
• Drug Safety Concerns (especially with newly approved drugs) There are a number of recent examples where a new drug was approved for use, entered the market and after more widespread use began showing harmful and even fatal patient side effects. Prior authorization criteria and procedures allow ODS to communicate and/or express any specific safety and drug use concerns to physicians prior to ODS payment for such medications. This is especially important for newly FDA approved drugs with a potential for such problems. • Determination of Medical Necessity Prior authorization of certain drugs allows the physician to evaluate the patient’s medication use and to provide documentation to ODS that explains the medical necessity of a specific drug. The prior authorization mechanism provides ODS with information, which documents the physician’s actions and reasons for use of certain drugs, beyond the information contained on a prescription. In turn, this allows ODS to determine whether the med
