PA Policy Change

July 12, 2021

Effective Immediately

MEDICATION PRIOR AUTHORIZATION

Due to the overwhelming number of medications for which every insurance company is requiring a Prior Authorization (PA), there will be a fee of $25.00 for our staff to initiate the authorization.  You must contact the office to pay this fee prior to the medical assistant initiating the PA.  This is NOT a guarantee that your insurance company will approve the PA.  After you have paid the fee, your PA will be submitted to your insurance company within 10 business days.  After our submission, it will then be up to your insurance company to determine and notify you and your pharmacy of their decision.

To determine the status of your PA claim, you will have to contact your insurance company or your pharmacy for this information since our office is not notified for several weeks after the decision is made by the insurance company.

There are several alternatives that you may choose instead of a PA for your medication.

1. You can call your insurance company and provide the required information to them for the prior authorization.
2. You can contact your insurance company to find out what alternate medication choices you have within your insurance plan. You can then ask your provider if one of the alternate choices is appropriate in your situation.
3. You can pay a “cash pay” price at your pharmacy. Good Rx is an online resource that can help you find the pharmacy with the cheapest price for your prescription.