Prior Authorization (PA) Change Request 2025

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Prior authorization (PA) is an essential tool that is used to ensure that drug benefits are administered as designed and that plan members receive the medication therapy that is safe, effective for their condition, and provides the greatest value.
Request Expedited Reviews from the Payer for Urgent Cases Healthcare providers must request an expedited review to speed up the prior authorization for urgent medication cases. If a patients condition requires immediate attention, healthcare providers must contact the payer to address the issue.
Ways to improve prior authorization in California include requiring payers to use automated systems for prior authorizations and limiting how often prior authorization is needed for ongoing treatments.
Can a prior authorization request be withdrawn? Yes. A prior authorization request can be canceled once it is submitted. Often this will occur when a prior authorization request is pending.
How long does a prior authorization take? Depending on the complexity of the prior authorization request, the level of manual work involved, and the requirements stipulated by the payer, a prior authorization can take anywhere from one day to a month to process.
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The requestor may resubmit another prior authorization request with all documentation to support medical necessity and any additional documentation needed as indicated in the detailed decision letter.

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