Referral & Prescription Prior Authorization Information

Referrals
Our dedicated Referral Coordinator can assist you with your referral by recommending specialists within your insurance plan, coordinate record transfers, and with other issues that emerge during the referral process.

To contact our Referral Coordinator, please call our office at 919-848-2229 extension 100.
 
Medication Prior Authorization
To fill a prescription, the pharmacy has to process both your prescription and benefit information. They may then get a notice from your insurance company that a prior authorization is required before they can fill the prescription. The pharmacy faxes a prior authorization request form to your physician office. We submit prior authorizations requests within 48 hours of receiving the request from your pharmacy. Once we’ve sent the information to your insurance company, they have up to 5 business days to notify your provider either approval or denial of the prescription requested. You can be proactive and contact your insurance company to get a status update. This can sometimes help to make the process quicker.

Help Prevent Authorization Delays or Problems
Always present your insurance card at every visit at your Physicians’ office.  Some insurance plans have a separate pharmacy benefit card. Make sure to keep both cards with you at all times. The number one reason for delays in obtaining prior authorization is incorrect insurance information.

ADD/ADHD Refill Medication Policy
Patients’ must be current on their ADD/ADHD follow-up appointments and annual physical exams; if not, an appointment must be made before refills can be requested. This does not guarantee that your medication will be refilled.
 
We ask that refill request be made 7 days in advance.  Please be aware there is a minimum 5 business day notification required.  ADHD medications are not considered emergency medications.  Refills will not be handled on weekends or holidays.
 
Recent Insurance and Medication Changes
As of 4/1/2017, due to Health Insurance Utilization Management changes, your prescription benefit plan may require prior authorization for your ADD/ADHD medication.  Please contact your insurance company and ask them ‘which ADD/ADHD medications are covered in your preferred medications benefits’. To assist you, we have posted a list below of commonly prescribed medications used to treat ADD/ADHD.

ADD/ADHD Meds Commonly Prescribed Medications (Brand and Generic)
Short-Acting:                                                  
Adderall          Amphetamine/Dextroamphetamine
Focalin          Dexmethylphenidate                              
Ritalin, Methylin          Methyphenidate    


Long-Acting:
Adderall XR          Amphetamine/Dextroamphetamine XR
Focalin XR          Dexmethylphenidate XR
Concerta,Metadate CD/ER, Ritalin LA/SR, Methylin          Methylphenidate ER
Adzenys XR-ODT          No Generic
Daytrana          
No Generic
Evekeo          No Generic
Quillivant          
No Generic
Vyvanse         No Generic

Non-Stimulant:                                                                                       
Strattera          Atomoxetine                                                          
Intuniv          Guanfacine                
Kapvay, Catapres          Clonidine                                                                                                   

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