Hey Tim, my pharmacy tells me they can’t fill my prescription because it is a Prior Authorization, or PA. WHAT’S UP WITH THAT?

A Prior Authorization is needed when your insurance company refuses to accept or pay a claim from your pharmacy for a prescription written by your doctor. Many times your pharmacy submits paperwork to your doctor and the doctor to the insurance company in an effort to get the claim paid and the prescription filled. Prior Authorizations can occur when your insurance company insists that there is a lower cost therapeutic alternative to the medication you were originally prescribed. They also occur when the insurance company insists that the medication you were prescribed is not the best thing for your overall health. While we both might disagree with either of these reasons, the insurance company still holds the final say as to whether the claim is paid. Sometimes the process may take up to 72 hours before a final verdict is received. You always have the option of paying cash and bypassing the insurance company based on the medication cost and your budget. Prior authorizations aren’t fun for anyone but with good communication between your pharmacy, your prescriber, and you most are resolved fairly quickly and with a positive result.


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