What is a prior authorization?
Under medical and prescription drug plans, certain medications may need approval from your health insurance carrier before they鈥檙e covered.
It is not a referral or a pre-authorization. Prior authorization is an approval that 最新糖心Vlog STAR Medicaid requires for certain services and medications. Some services need approval before they are given. The provider who is treating your child should get this approval. You can ask your doctor or us if an approval is needed for a service or treatment.
What types of medications typically need approval?
- Those that may be unsafe when combined with other medications
- Have lower-cost, equally effective alternatives available
- Should only be used for certain health conditions
- Are often misused or abused
- Drugs often used for cosmetic purposes
- Medications that require approval will only be covered by your plan if your doctor requests and receives approval from your health insurance company.
What鈥檚 the difference between prior authorization and pre-authorization?
None; these terms mean the same thing and are used interchangeably. However, most insurance companies will use the term 鈥減rior authorization鈥� instead of 鈥減re-authorization.鈥�
How does the prior authorization process work?
Prior authorizations for prescription drugs are handled by your doctor鈥檚 office and your health insurance company. Your insurance company will contact you with the results to let you know if your drug coverage has been approved or denied, or if they need more information.
If you are unhappy with your prior authorization decision, you or your doctor can ask for a review of the decision, or your doctor may prescribe a different but equally effective medication. In some instances, your health insurance company may recommend you try an alternative medication that鈥檚 less costly, but equally effective, before the medication your doctor originally prescribed can be approved.