Prior Authorization Explained

prescription insurance plans

You go to the pharmacy and your prescription is not ready, the staff tells you your insurance requires prior authorization.  What does this mean?

Prior Auths (or simply PAs) are frustrating for both pharmacies and patients.  It has nothing to do with your medication having refills – it simply means your insurance will not cover the medicine without having more information.


Why won’t the insurance cover the medication my Doctor has prescribed?

 

There can be many reasons.  You may call the customer service number on your prescription drug card to find out for the exact reason.

Some reasons could be:  there is a generic alternative, the medication is potentially dangerous, there is a potential for abuse or some other cost savings.

With the skyrocketing cost of healthcare and medications most insurance companies are trying to keep cost low.  It every expensive medication was covered by insurance premiums would be even higher than the are now.

Ask your pharmacist is there are alternative medications you could suggest  to your Doctor.  Also, most prior authorizations take 2 to 3 business days to process — please allow your pharmacy and Doctor’s Office time to work on the request to your insurance.  If the authorization is denied or the Dr. won’t give prior authorization unfortunately you are left with two choices: pay the cash price or go without the medication.

Comment Below! Because we’d like to hear your experience or further questions

Disclaimer

The pharmaceutical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment.
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