What is a prior authorization (PA)?
A prior authorization (also called a pre-authorization or PA) is an approval process set by some insurance plans before certain services, prescriptions, or equipment can be covered.
If you’re uninsured or choose to self-pay, then a prior authorization doesn’t apply.
Why it matters
The prior authorization process helps ensure your medication is appropriate for your care and covered by your insurance, reducing the risk of unexpected costs or delays at the pharmacy.
To limit the risk of unexpected costs or delays, confirm with your insurance if a prior authorization is needed before receiving care. This includes filling prescriptions or ordering equipment.
If a PA is required and not obtained, you may be responsible for the full cost, even if the service is usually covered.
Tip: If you'd like to confirm whether your medication needs a PA you can always check with your insurance or start a chat with your Care team on the mobile app or web portal.
How the prior authorization process works
Your pharmacy notifies your provider if a PA is required.
Your provider submits the request to your insurance to explain why the medication is needed.
Your insurance reviews the request and shares their approval or denial decision with you, your provider, and your pharmacy. This usually takes 3-5 business days, sometimes longer.
Your pharmacy is notified by your insurance about the prior authorization approval, and processes your prescription accordingly.
What to do if you haven’t received an update from your insurance about your prior authorization status
Wait 5 days for insurance to process the prior authorization request.
Then, call the member services number on the back of your insurance card to confirm whether the prior authorization was approved or denied.
If approved: Call your pharmacy to get a time estimate for when your medication will be ready.
Questions? Start a chat with your Care Team on the mobile app or web portal, and they’ll be able to support you.