If you’ve been told your medication requires a prior authorization, you’re not alone; this is a common step required by many insurance plans. This article will cover what a prior authorization is and what you can expect.
What is a prior authorization?
A prior authorization (PA) is when your insurance company requires your provider to submit additional information before they approve coverage for a medication.
This is required by your insurance, not by your provider or our support team.
Why do prior authorizations happen?
Insurance companies may require a PA to:
- Confirm the medication is medically necessary
- Suggest a lower-cost alternative first
- Ensure the medication is covered under your plan
Who submits the prior authorizations?
Your provider (prescriber) is responsible for submitting the prior authorization to your insurance. Our role is to help coordinate communication between you, your provider, and your pharmacy, but we cannot submit or approve prior authorizations.
How long does it take?
Prior authorizations typically take:
- 2 - 5 business days, but this can vary depending on your insurance provider
How do I check the status?
For the most up-to-date information, you can contact:
- Your pharmacy can confirm if the PA is required or received
- Your insurance company will check the approval status
What if my prior authorization is denied?
If your insurance denies the request:
- You can contact your insurance provider for details (the number is usually on the denial notice)
- Your provider may suggest alternative medications or next steps