Prior authorization is the requirement for the providers that medical practitioner obtain approval related to your proposed treatment or service. It is a kind of review to check whether the medications cover in your Insurance claim. It is a process to ensure if the medication is medically essential for enhancing the patients’ health. Physicians will get a pre-authorization request from the concern Insurance Company for the use of a particular drug. The Insurance Company will cover only the cost of medications after confirmation of a prior authorization request.

Prior Authorization requirements:

  • Need for a prior authorization request.
  • Drugs which are not harmful or used to treat non-life threatening patients.
  • Drugs that are necessary for you under doctor prescription but aren’t covered by the Insurance Company.
  • Drugs with dangerous side effects.
  • Drugs meant for certain age groups only.
  • Brand name drugs prescribed after the availability of Generic drugs.
  • Prior Authorization is an examiner in ensuring whether the drug usage is exact, clinical & cost-effective therapy employed.