Question

A patient brings in a prescription for a brand-only medication that requires a prior authorization. You...

A patient brings in a prescription for a brand-only medication that requires a prior authorization. You explain the process to the patient, and she asks to order it right away.

You check your supplier, and see the cost is over $800.

What do you do?

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Answer #1

Ask the patient to get prior authorisation

Your doctor will start the prior authorization process. Usually, they will communicate with your health insurance company. Your health insurance company will review your doctor’s recommendation and then either approve or deny the authorization request. In some cases, your insurance company will ask for more information from your doctor in order to make a decision.

Under medical and prescription drug plans, certain medications may need approval from your health insurance carrier, before they’re covered. For example, if you’re a Cigna customer, these medications have a (PA) next to them on your plan’s drug list.

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