The Washington Preferred Drug Line (PDL) Prescription Authorization Request is a form used to request authorization for medications that are not listed on the PDL. This form is used by healthcare providers when a medication that is not on the PDL is clinically necessary for a patient’s care. It is also used to request authorization for medications when the prescribing physician believes that a medication listed on the PDL is not the most clinically appropriate for the patient. The Washington Preferred Drug Line Prescription Authorization Request includes two types of requests: Standard Authorization Requests and Complex Authorization Requests. Standard Authorization Requests are for medications that have Washington State Medicaid reimbursement and are clinically appropriate for the patient’s condition. Complex Authorization Requests are for medications that do not have Washington State Medicaid reimbursement or are not clinically appropriate for the patient’s condition. In order to submit a Washington Preferred Drug Line Prescription Authorization Request, healthcare providers must provide information such as patient information, prescription details, diagnosis code, clinical justification/rationale for the request, and any other relevant information. The PDL team will then review the request and make a determination whether the medication should be authorized or denied.
Washington Preferred Drug Line Prescription Authorization Request
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FAQ
Prior authorization is an approval of coverage from your insurance company, not your doctor. It's a restriction put in place to determine whether or not they will pay for certain medicines. It doesn't affect cash payment for prescriptions. Plus it's only required on those prescriptions when billed through insurance.
Prior authorization?sometimes called precertification or prior approval?is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
What is WA (Well Authorization)? - Definition & Meaning. WA: Stands for Well Authorization. Well authorization refers to approval or agreement required to perform a specific activity.
Prior authorization ensures that you get the prescription drug that is right for you and that is covered by your benefit. If it's determined that your plan doesn't cover the drug you were prescribed, you can ask your doctor about getting another prescription that is covered. You'll receive it for your plan's copayment.
Prior authorization requires the prescriber to receive pre-approval for prescribing a particular drug in order for that medication to qualify for coverage under the terms of the pharmacy benefit plan.
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 doctor can initiate the prior authorization process by calling Express Scripts toll-free at 800?417?8164 or by fax at 800?357?9577. If you plan to fill your prescription at a retail pharmacy, consider completing the prior authorization with your doctor before you go to the pharmacy.
Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, Danazol, Nandrolone, OxandrinAnticoagulantsEliquis, Pradaxa, XareltoAntipsoriatic AgentsOtezla, Stelara, Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi240 more rows
