Prior Authorizations
Members with medications that require an updated prior authorization on or after January 1, 2025 will receive a letter in the mail explaining the approval process, the prior authorization expiration date, and what information you need to discuss your provider. If you or your provider have started the prior authorization process, no further action is needed.
What is a prior authorization?
Generally, drugs that are prone to misuse or high cost require a prior authorization (PA). These medicines must meet certain criteria to ensure that the drug is used appropriately. Doctors and pharmacists at your health plan work with Prime Therapeutics to determine which require a prior authorization.
How do I get a prior authorization for my medicine?
Talk with your doctor. If you need a drug that requires a prior authorization, your doctor will fill out a prior authorization request form to submit to your health plan. If the request is approved, your prescription can then be filled by a pharmacy. If the request is not approved, talk to your doctor about possible medicine alternatives.
