Get General/Non-Preferred Drug Prior Authorization Form - Catamaran

For urgent or expedited requests please call 1-855-297-2870. This form may be used for non-urgent requests and faxed to 1-844-403-1029. OptumRx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations.

In most cases, the services that require this approval are those deemed expensive or high-risk. For many carriers, the following services require prior approval: Diagnostic imaging such as MRIs, CTs and PET scans. Durable medical equipment such as wheelchairs, at-home oxygen and patient lifts.

What types of prescriptions require prior authorizations? Brand-name drugs that have a generic available. Drugs that are intended for certain age groups or conditions only. Drugs used only for cosmetic reasons. Drugs that are neither preventative nor used to treat non-life-threatening conditions.

Prior Authorization is recommended for prescription benefit coverage of extended-release products. extended-release products are controlled substances (CIV) which can be misused and abused.

Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

Prior Authorizations Preauthorization. Preapproval. Precertification.

Prior authorization (PA) requires your doctor to tell us why you are taking a medication to determine if it will be covered under your pharmacy benefit. Some medications must be reviewed because they may: Only be approved or effective for safely treating specific conditions.

In summary “Refill too soon” rejections happen because a patient is trying to get their medication before the payer believes it is time. In some cases, the pharmacist can override the rejection.