How prior authorizations work

We use a coverage review called prior authorization to ensure certain medications are used safely, appropriately and in line with clinical guidelines, while also helping to manage costs.

  • Click here for tips on how to read the prescription drug formulary and to find a list of medications that require prior authorization. Click here to see the prescription drug formulary and to find the code (PA) indicating which medications require prior authorization.
  • If a prior authorization is needed for your prescribed medication, contact your provider and ask them to submit the request and needed clinical information. Most reviews are completed within 15 days.
  • If your prior authorization request is denied, you and your provider will receive a letter explaining why. A denial doesn’t necessarily mean the medication is inappropriate for your treatment. The reviewer may just need more information from your provider to move forward. Reasons can include incomplete documentation, or the need to try a lower cost formulary alternative first.
  • Your letter will explain next steps, with contact information for the partnering company managing the request, either Luminare, Judi Rx or Archimedes.

Pharmacy Resource Guide