Insurance Update

as of 3/2/2015

New Challenges for Medication Prior Authorization in 2015:
With the start of the New Year, your insurance plan may have changed some of your plans health benefits, policy number, group number or prescription plan benefits. You may have received a benefits notice, new cards or new formulary coverage from you Health Insurance Company. It is not uncommon to think that the cards were the same or to throw out the formulary wondering why they sent it to you. The next thing you know, you are at your pharmacy to pick up your prescription, only to find out that it NOW needs 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 process prior authorizations requests within one week of receiving the request from your pharmacy. Once we’ve sent the information to your insurance company, it may take up to 5 business days to hear back from them for either approval or denial. If it has been over a week, you can be proactive and contact your insurance company to get a status update. This can sometimes help to make the process quicker.

Help Preventing Authorization Delays or Problems:
Always present your insurance cards at every visit at your physicians office.  The number one reason for delays in obtaining prior authorization is incorrect insurance information. When you get new insurance cards from your insurance company, make sure to put away the old card and only keep the new one with you. Some insurance companies now have separate medical and prescription cards, make sure to always have both on you at all times. 

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