Get Capsule Prior Authorization Request

Prior authorization requires the prescriber to receive pre-approval for prescribing a particular drug in order for that medication to qualify for coverage under the terms of the pharmacy benefit plan.

Patients may even wait days, weeks or months for a necessary test or medical procedure to be scheduled because physicians need to first obtain similar authorization from an insurer. This tactic, used by insurance companies to control costs, is called prior authorization.

What types of prescriptions require prior authorizations? Brand-name drugs that have a generic available. Drugs that are intended for certain age groups or conditions only. Drugs used only for cosmetic reasons. Drugs that are neither preventative nor used to treat non-life-threatening conditions.

Capsules include medication that's enclosed in an outer shell. This outer shell is broken down in the digestive tract and the medication is absorbed into the bloodstream and then distributed and metabolized in much the same way as medication from a tablet.

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 insurance company may require prior authorization before covering certain prescriptions. This is to ensure that the medication is appropriate for your treatment. It also helps to make sure it's the most cost-effective option. When prior authorization is granted, it is typically for a specific length of time.

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.

They can always call (888) 910-1808.