What if the medication the physician requested is denied?
When a medication request is denied, alternative treatment options, which are covered under the benefit, are provided to the physician. Each case is reviewed individually and decisions are made based on medically sound clinical criteria developed and/or approved by one of our physician committees. • If the prior authorization request for a specific medication is denied, the drug is considered a non-covered benefit. It is not available as a third-tier medication.
Related Questions
- The physician has written a prescription with a long acting medication and a short acting medication on the same duplicate prescription. How do I enter that on-line for submission to the Program?
- What if the medication or service the provider requested is denied?
- What if the medication the physician requested is denied?
