Insurance companies are making it much harder for people to get the medications their doctors prescribe. Here are some things you should understand about how insurance handles prescriptions:
1) Insurance may require a ‘prior authorization’ before the prescription can be filled. This means that after the prescription is written and goes to the pharmacy, the insurance company then wants another authorization from the doctor’s office before allowing the pharmacy to fill the prescription.
2) To get a prior authorization, the pharmacy will fax the prescribing doctor with a request. The doctor must then fill out paperwork and submit it to the insurance. The insurance will then review the paperwork and make a decision about whether or not they will authorize the medication. If accepted, the insurance must contact the pharmacy to permit the prescription. If not accepted, the insurance will send a letter or fax to the doctor or the patient explaining their decision.
3) The prior authorization process can take anywhere from 8 hours to 4 weeks to complete. At CPCH, we complete the prior authorization immediately; however, many psychiatry practices do not have administrative staff to help with this and it can take much longer.
4) If the prior authorization is accepted, it may have limitations like:
- the quantity(pills) they will cover under your plan for approval
- may require a different medication to be substituted
- require another prior authorization in 6 months
What can you do as a patient to make this process smoother?
1. Ask your insurance provider for a listing off all generic and brand named medications that are covered under your plan.
2. Take this list with you when you go to your appointment and show it to your doctor.
3. Choose a psychiatry practice with a lot of experience with prior authorizations and an administrative staff member who is dedicated to this task.
If you have any questions about this, please feel free to use our chat option on our website or reach out to by email or phone. We are happy to assist you.
Live Mentally Healthy,
Dr. Jennie Byrne,