A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Single Pharmacy Benefit Manager Pharmacy Benefits Gainwell Technologies covers all Medicaid-covered, medically necessary prescriptions, certain over the counter (OTC) medications, vaccines, and select durable medical equipment.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

Prior Authorization is a cost-savings feature of your prescription benefit plan that helps ensure the appropriate use of selected prescription drugs. This program is designed to prevent improper prescribing or use of certain drugs that may not be the best choice for a health condition.

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you don't get prior authorization, a medication may cost you more, or we may not cover it.

Your insurance company may require prior authorization before covering certain prescriptions. This is to ensure that the medication is appropriate for your treatment. It also helps to make sure it's the most cost-effective option. When prior authorization is granted, it is typically for a specific length of time.