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Prior authorizations are required by insurance companies for some medications. This includes those that may have less expensive alternatives. The prior authorization process usually takes about 2 days. Once approved, the prior authorization lasts for a defined timeframe.

Prior authorization is a program that monitors certain prescription drugs and their costs to get you the medication you require while monitoring your safety and reducing costs.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Prior Authorizations Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.

A pre-authorization is a restriction placed on certain medications, tests, or health services by your insurance company that requires your doctor to first check and be granted permission before your plan will cover the item.

Your doctor can initiate the prior authorization process by calling Express Scripts toll-free at 800‑417‑8164 or by fax at 800‑357‑9577. If you plan to fill your prescription at a retail pharmacy, consider completing the prior authorization with your doctor before you go to the pharmacy.

What happens if prior authorization is denied? If your insurance company denies pre-authorization, you can appeal the decision or submit new documentation. By law, the insurance company must tell you why you were denied. Then you can take the necessary steps to get it approved.

The prior authorization process begins when a service prescribed by a patient's physician is not covered by their health insurance plan. Communication between the physician's office and the insurance company is necessary to handle the prior authorization.