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Why does Express Scripts require prior authorization?

When your pharmacist tells you that your prescription needs a prior authorization, it simply means that more information is needed to see if your plan covers the drug. Only your doctor can provide this information and request a prior authorization. 2.

Does Express Scripts require prior authorization?

Certain prescription medications need to be preapproved by Express Scripts before they will be covered. This preapproval process is known as prior authorization. If you do not receive approval for drugs requiring prior authorization, you may pay the full cost of the medication.

What does prior authorization mean at Express Scripts?

Prior authorization ensures that you get the prescription drug that is right for you and that is covered by your benefit. If it's determined that your plan doesn't cover the drug you were prescribed, you can ask your doctor about getting another prescription that is covered. You'll receive it for your plan's copayment.

What is a prescription authorization request?

Special Authorization and Prior Authorization are interchangeable terms we use to describe a pre-approval process that helps us determine if certain prescription drugs will be reimbursed under your benefit plan. Most drugs that require prior authorization are considered high-cost specialty drugs.

How do I send to Express Scripts?

To get started, you simply need to make the request through Express Scripts Member Services or online at www.express-scripts.com. You will need to choose the medication(s) you want to transfer to Home Delivery and confirm the prescribing doctor information so that ESI can contact the doctor on your behalf.

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What does it mean to need a prior authorization?

What is a Prior Authorization? A prior authorization (PA), sometimes referred to as a \u201cpre-authorization,\u201d is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

What does a prior authorization mean Express Scripts?

Prior authorization ensures that you get the prescription drug that is right for you and that is covered by your benefit. If it's determined that your plan doesn't cover the drug you were prescribed, you can ask your doctor about getting another prescription that is covered. You'll receive it for your plan's copayment.

How long does Express Scripts prior authorization take?

If your physician's office calls with all relevant medical information including member name, member ID number, diagnosis and past medication history, we may be able to provide a prior authorization decision during the call. If the request is faxed, it may take up to 24 to 72 hours for a decision.

How do I submit prior authorization to Express Scripts?

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

What is the prior authorization process?

Prior authorization\u2014sometimes called precertification or prior approval\u2014is 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.

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Why does Express Scripts require prior authorization?

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