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Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part.
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.
A prior authorization (PA) review is used for a wide variety of medications to confirm that medication is being prescribed for its intended use based on FDA guidelines. These reviews are meant to ensure certain prescriptions meet specific criteria before they are covered by a pharmacy plan.
The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.