What is a prior authorization and step therapy?
Certain prescription drugs (or the prescribed quantity of a drug) may require “prior authorization” before members can fill prescriptions. Some drugs require prior authorization because they may not be appropriate for every patient or may cause side effects. The physician should have a current list of drugs requiring prior authorization. However, the physician may call our referral number for authorization and information regarding these requirements. Prior authorization helps promote appropriate utilization and enforcement guidelines for prescription drug benefit coverage.
