Prior Authorization: What is it?

Oct 4, 2021

Prior authorization (PA), also commonly known as pre-authorization, is a process where you must receive approval from your insurer prior to getting a prescription medication. In this case, you may only be able to receive a prescription under your insurance if it has been approved by your insurance company prior to the pharmacy giving you the medication. 

The entire authorization process varies depending on your insurer and your plan. In addition, the amount of research and time you can expect it to require depends on the severity of your illness, difficulty in accessing other alternatives, and the medications you are being prescribed.

What Medications Need Approval?

Insurance companies often require prior authorizations for the following medications:

  • Drugs used only for cosmetic purposes
  • Drugs used only for certain health conditions
  • Drugs that are often misused or abused
  • Brand-name drugs that have a lower-cost alternative available
  • Drugs that may have adverse health effects and possibly dangerous interactions

Prior Authorization: The Good and the Bad

The prior authorization process is handled by your doctor’s office and your health insurance company. In some cases, this involves your doctor completing a form to inform your insurance company why the drug you are being prescribed is deemed medically necessary. After all the paperwork and once everything has been decided, your insurance company will contact you with the results, letting you know if your medication coverage has been approved or denied. 

Prior authorization is not always bad news. Sometimes these plans have made prescription drugs more accessible for patients, as many plans actually encourage doctors to try alternative methods or medications before pursuing their most expensive options. This ensures that patients will have a cheaper treatment option to turn to before having to resort to a more expensive one.

Other benefits of prior authorization include:

  • Allows your health insurance company to review your prescriptions, ensuring there are no potentially dangerous drug interactions that may occur
  • Help prevent you from being prescribed medications you may not necessarily need
  • Help prevent you from being prescribed medications that may be potentially addictive

However, prior authorization can create a serious barrier for many people receiving medication that are unaware of this process. If your insurance plan requires prior authorization and you have not yet submitted your application or approval is pending, then you should contact the customer service department of your insurer before receiving medication. You should also ask your doctor if your prescription medication will require authorization so the process can start immediately. 

Getting Prior Authorization with Phox Health Prescription Delivery

It is important to be aware of the prior authorization process when you are prescribed a new medication. This ensures that you can receive your prescription from your doctor and get started with treating your illness or condition as soon as possible. If your prescription requires a prior authorization, the Phox Health partner pharmacy will notify your healthcare provider, who will then provide the necessary information to your insurance company. From there, we will complete your prescription delivery so you can rest assured you get your medications when you need them!

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