Prior Authorizations
We provide prior authorization support on your behalf.
What is Prior Authorization (PA) for Medication?
For psychiatric medication, a Prior Authorization (PA) is simply permission that your provider must get from your insurance company before they will cover the cost of a specific drug.
Why Does My Insurance Do This?
The insurance company uses PA to save money by ensuring two things:
Cost Control: They want to make sure you try the cheaper, often generic drugs on their Preferred List first.
Medical Necessity: They want your provider to confirm that you absolutely need this specific, more expensive drug and that you have not responded well to the less expensive alternatives.
How Do I Know If I Have A Prior Authorization?
Your provider might tell you during the appointment.
Your Pharmacy will tell you before being dispensed.
What Can I Do About having a Prior Authorization?
Call your provider to expedite the process.
Wait: Give our office 48 business hours for the submission process (this make take longer over days that providers are out of the office). Please do not call every day for prior authorizations.
Call the Pharmacy: Call your pharmacy and ask, "Has the prescription been approved by my insurance yet?"
Call Your Insurer (or PBM): Call the phone number for Pharmacy Benefits on the back of your insurance card. Tell them the medication name and ask for the STATUS and the PA Reference Number.
What Happens If It's Denied?
If the PA is denied, your insurance will not pay for the drug. You have two main choices:
Switch: Ask your prescriber to switch you to a similar, cheaper drug that is on your insurance company's Formulary.
Appeal: Ask your prescriber to formally argue and prove to the insurance company that the prescribed medication is truly the best—or the only—safe and effective option for you.
