Patient Support Program

A man purchasing prescription medication at the pharmacy checkout.

How do I know if the medication the patient has been prescribed requires prior authorization?

Most patients you encounter as a PSP will have been prescribed a specialty drug requiring prior authorization by their physician. A drug requires prior authorization if one or more of the following applies:

  • If the drug is not immediately available to a patient through their local pharmacy with a prescription
  • If both the patient and their prescriber must both complete claim forms and the prescriber must provide medical evidence before the patient’s insurer will agree to consider reimbursement of the drug(s).

If you are unsure if the drug requires prior authorization and assistance from a PSP, insurance companies or pharmacy benefit managers (payers) will often have a prior authorization drug list on their website for drugs that require prior authorization. Some may include the required claim forms that can be printed for your use, but others may not.