Many times, we find ourselves at the pharmacy trying to fill a prescription, when we hear the words, “It’s not going through – denied for prior authorization”. Some may wonder why a drug would require prior authorization, when the doctor already wrote the prescription. Isn’t that “authorization” enough?
In many cases, a prior authorization is often necessary to try to save costs, however, it is sometimes needed to be sure the drug is right for the patient.
If a drug needs approval, either the patient or the pharmacist will need to let the doctor know. The doctor might switch the patient to another drug that doesn’t need prior approval. Or, they can contact the insurance company’s Pharmacy Help Desk to start the approval process. Approval for some drugs requires an actual form to be filled out and faxed in, others can be authorized with a simple phone call between the doctor and the Pharmacy Help Desk.
It is always a good idea to follow up with the doctor’s office staff to see what their normal turnaround time is for these types of requests. If the need for the drug is urgent, that should be communicated to the physician’s staff as soon as possible.