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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 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.
The Simplify Prior Authorization initiative is an advocate for education about prior authorization (PA) and improvement in current prior authorization practices and processes. If your organization is interested in finding out more, getting involved, or in sponsorship of this important initiative, please contact us via the link below.
