05/01/2024
In today's world of medicine, there are new pharmaceuticals hitting the market daily. Currently, there is a big demand for new medications that aide in weight loss. We are taking this time to cover information that may assist you if you are planning to consult with your provider to see if the medication could be right for you.
First, even when your provider believes you would benefit from a particular medication, your insurance plan may not cover it and you would have to pay out of pocket for the medication. Or your insurance will require what is called a prior authorization before they will consider covering the prescription.
After the prescription is sent to the pharmacy, they will let your provider know if an authorization is required. The provider's office will then have to complete forms and submit a formal authorization request to your insurance. Your insurance provider may want you to fill out and sign some forms. The insurance company will alert you, your physician, or your pharmacy once they have approved or denied the request.
Prior authorization can take days to process, and it depends on what medication your physician is prescribing and the insurance company providing approval for coverage. According to an American Medical Association, physicians staff whose only job is to work on prior authorizations, spend approximately 15 hours or more per week just to complete forms. Generally, within 5-10 working days, you can call your pharmacy to see if the prior authorization request was approved by your insurance. If it wasn’t, you can call your insurance company to see why the authorization was delayed or denied. At that time, you may be fully responsible to pay for the medication out of your pocket.
Remember, even if the provider thinks it will be of benefit to you, it may not be a covered item under your insurance plan.
