PRIOR AUTHORIZATIONS

MY PHARMACY SAID MY INSURANCE IS NOT COVERING THE MEDICATION

  1. Ask the pharmacist if your PA’s office can submit a prior authorization to get your medication covered.
  2. If the answer is yes then scroll down to how does your office process prior authorizations.
  3. If the answer is no then schedule an appointment that will occur before you run out of your current medication.  At this appointment we will determine the new treatment plan.

HOW DOES YOUR OFFICE PROCESS PRIOR AUTHORIZATIONS?

Your insurance may have a system in place that requires a prior authorization for certain medications.  The pharmacy will inform you if your medication requires a prior authorization.  

  1. Your pharmacy will need to initiate the prior authorization through covermymeds.com.  Once the pharmacy completes their part of the form they need to fax us the key code, which allows us to complete the prior authorization.  

If the medication is Vyvanse, Adzenys, or Mydayis:

  1. Instruct your pharmacy to use your coupon to fill your medication right away.  If you were not given a coupon in the office then then go to your internet browser and type the name of the medication followed by .com.   This should take you to the w
  2. Keep your follow up appointment that was scheduled for 2 weeks after starting your medication.  At that time we determine if the medication is going to be continued.  If it is determined that the medication will be continued then send Marissa a message through the portal and ask her to complete the prior authorization.
  3. To check in on the progress of the prior authorization send Marissa a message through the patient portal.

For all other medication:

  1. Make sure you have a week left of your current medication so that you do not run out while we are processing the prior authorization.
  2. To check in on the progress of the prior authorization send Marissa a message through the patient portal.

HOW LONG DOES IT TAKE TO COMPLETE THE PRIOR AUTHORIZATION?

Due to the high volume of prior authorizations it could take our office several business days to complete the authorization.  Once completed your insurance company will either approve or deny the authorization, which can take several business days as well.    Once your insurance has made a determination, they will send a notification to you, our office, and the pharmacy.  If your  insurance denied the prior authorization then schedule an appointment that will occur before you run out of your current medication.  At this appointment we will determine the new treatment plan.