Prior Authorizations

Prior Authorization Program:

  • Clients may request prior authorization services to ensure that drug benefits are administered as designed and that patient/members receive medication therapy that is safe and effective and provides the greatest value. Prior authorization criteria guidelines include the most current literature, evidence-based medicine guidelines, and FDA approved indications. Implementing prior authorization can be an effective method of managing leaky spend within your pharmacy program.

Prior Authorization with Clinical Care Support Program:

  • Clients may request prior authorization with clinical care plan criteria to support their individual prior authorization process.  Clinical expertise can be provided for consultation and recommendations for more complex cases that may involve specialty drugs, ethical dilemmas, compounded drugs, or specialized drug therapy. Patients are contacted and engaged in a Motivational Interviewing (MI) approach to empower the patient and improve adherence. Communication and monitoring of physician goals are also included. Adherence outcomes are tracked and reported.