Get the free Drug Prior Authorization Request Form

This form is used to request prior authorization for medication by providing necessary patient and prescriber information, medication details, and rationales for the request.

How to fill out drug prior authorization request

How to fill out Drug Prior Authorization Request Form

1. Obtain the Drug Prior Authorization Request Form from your healthcare provider or the insurance company's website.
2. Fill in the patient's personal information, including name, date of birth, and insurance details.
3. Include the prescribing physician's information and signature.
4. Specify the medication requiring prior authorization, along with dosage and duration.
5. Provide clinical information supporting the need for the drug, including previous treatments and medical history.
6. Attach any additional documentation, such as lab results or previous medication trials.
7. Review the completed form for accuracy and completeness.
8. Submit the form to the health insurance company via the specified method (online, fax, or mail).
9. Follow up with the insurance company to confirm receipt and status of the request.

Who needs Drug Prior Authorization Request Form?

1. Patients who are prescribed certain medications that require prior approval from their insurance company before coverage.
2. Healthcare providers submitting prescriptions for these medications on behalf of their patients.
3. Pharmacies that need to verify insurance coverage for specific drugs before dispensing.

People Also Ask about

What is a pre-authorization form?

Prior authorization — sometimes called preauthorization or precertification — is a health plan cost-control process by providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

How long do pre-authorizations take for prescriptions?

How long does prior authorization take? If you file an urgent request, we will have a decision provided in 72 hours or less. A standard non-urgent request may take up to seven days for us to make a decision. Learn more about the review of a non-covered drug, one not on our drug list.

What are three drugs that require prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Epidiolex Epidiolex Erythroid Stimulants , , Procrit and Retacrit, Mircera Esbriet Esbriet Evenity Evenity241 more rows

How long does pre-authorization take for medication?

Many prior authorization requests are processed in 1 to 3 business days, especially for standard medications with properly completed paperwork. Some insurance companies may take up to 5 to 7 days as part of their normal process.

How to ask for pre-authorization?

You can call your insurance company and ask about pre authorization and when they say yes it's needed, ask them to call your dr on your behalf because your dr is not being helpful with getting the ball rolling on the pre auth.

For pdfFiller’s FAQs

What is Drug Prior Authorization Request Form?

The Drug Prior Authorization Request Form is a document that healthcare providers use to obtain approval from an insurance company or pharmacy benefit manager before prescribing certain medications, ensuring that the prescribed drug is medically necessary.

Who is required to file Drug Prior Authorization Request Form?

Healthcare providers, such as doctors and pharmacists, are typically required to file the Drug Prior Authorization Request Form on behalf of their patients to secure authorization for specific medications deemed non-preferred or subject to increased scrutiny.

How to fill out Drug Prior Authorization Request Form?

To fill out the Drug Prior Authorization Request Form, a healthcare provider must provide patient information, details about the prescribed medication including dosage and quantity, rationale for the requested drug, and any relevant clinical history that supports the necessity for the medication.

What is the purpose of Drug Prior Authorization Request Form?

The purpose of the Drug Prior Authorization Request Form is to control healthcare costs, ensure that prescriptions are appropriate, and confirm that medications are prescribed based on clinical guidelines and medical necessity.

What information must be reported on Drug Prior Authorization Request Form?

The Drug Prior Authorization Request Form must include patient demographics, insurance information, provider details, the drug requested, dosage, frequency, existing medical conditions, previous treatments, and documentation of medical necessity supporting the use of the prescribed medication.