In most cases, brand-name prescriptions and expensive medications require prior approval. Prior authorization, or prior approval, is a procedure wherein the pharmacist must obtain approval from a patient's insurance company to pay for a medication, RXList.com states.
Insurance companies decide which costly medications they do and do not cover, which is why most prefer generic over brand-name medications. Additionally, drugs with age limits raise questions with an insurer. For example, Retin-A is a medication used to treat acne in teenagers. An insurance company may request prior approval for anyone other than those in that age group. Drugs that are not life-sustaining may require prior approval. Drugs to treat erectile dysfunction may require a call from a patient's insurance company. Alternately, drugs that are not covered by a patient's insurance but are considered medically necessary require prior approval. In this case, a doctor informs the insurance company that no other medications work in the patient's case, explains Consumer Health Information Corporation.
If a pharmacist tells a customer that his medication requires prior approval, the customer should contact the doctor informing them of the situation, as reported by Consumer Health Information Corporation. Customers may also have the doctor contact the insurance company and fill out any necessary forms to obtain prior authorization.