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Examples of services that commonly require prior authorization before being approved include: Diagnostic imaging (such as MRIs, CTs, and PET scans) Durable medical equipment (such as wheelchairs) Rehabilitation (like physical or occupational therapy)
Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAfinitorAfinitor, Afinitor Disperz, everolimusAmpyraAmpyraAmvuttraAmvuttraAndrogens-Anabolic SteroidsAndrol-50, Danazol, Nandrolone, Oxandrin242 more rows
Basic Information Required for the Prior Authorization Request The name and Medical Assistance ID number (i.e., ACCESS card number) of the beneficiary. The name and phone number of the contact person at the prescribers office. The prescribers specialty or field of practice.
Prior authorization is used to help plan providers ensure that their members are not being prescribed the most costly medication, until less expensive alternatives have been pursued. This cost check helps keep overall plan costs down and allows employers to continue offering drug benefits.
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.
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People also ask

Prior authorization specialists usually: Discuss medications, insurance and prior authorization documents with patients. Get prior authorization approval from insurance firms and nurse managers. Appeal insurance companies after prior authorization refusals. Assess accounts for completeness and accuracy.
Prior authorizationsometimes called preauthorization or precertificationis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
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.

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