How would you explain prior authorization to a patient?
Sigiloso
This medication is not listed on your insurance's list of approved medications (formulary). However, they do offer for your MD to fill out some paperwork and return to them, to help them better understand why your MD chose a medication that is not on their formulary. After reviewing the paperwork from the MD, they will decide to either cover the medication and let us know that it is now covered, or they will not cover it and let your MD know he needs to prescribe something similar that is on their formulary. This process, depending on your MD and insurance, can take anywhere from 24hours to weeks to months.