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Prior Authorizations: what can you do to help your prescribers

Prior Authorizations (PAs) are forms that are completed by the prescriber or prescriber’s agent (person that completes the form for the prescriber’s signature) for the patient to receive his or her medication. Reason’s for prior authorizations include: cost of the medication, the quantity of medication prescribed, early refills, off label use of a medication, or simply because the medication is not on the patient’s drug formulary.

Out of the many questions and answers regarding prior authorizations, the key information that the pharmacy will need to provide the prescriber with are as follows:

  1. National Provider Identification (NPI) of the Pharmacy
  2. Street Address, Fax Number, & Phone Number of the Pharmacy
  3. National Drug Code (NDC) of the medication in format 00000-0000-00 (first five digits are drug manufacturer, second four digits are drug identifier, last two digits are drug package size)
  4. Inform the prescriber of the package sizes that are available; some drug products only come as kits, unit dosed packages, or need to be reconstituted.
  5. The patient’s pharmacy benefits Identification number

The prescriber or prescriber’s agent can complete the process by adding the following information to the PA:

  1. Prescriber’s NPI, if unknown this can be searched via: NPI Lookup
  2. ICD-10 code that matches the diagnosis of the patient
  3. Street Address, Fax Number, & Phone Number of the Prescriber
  4. Last, but certainly not least..Get the Prescriber Signature!

Lastly, a good resource for prescribers and pharmacies is the website covermymeds. The site can be linked into your pharmacy’s software and faxes can be automatically sent to the prescriber with some rejection codes. For prescribers this is a great resource to complete PA’s electronically, and it gives you electronic access to the correct PA forms that correlate with the patient’s pharmacy benefit plan.

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

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  1. Pingback: Lecture 8 — April 25, 2018 |

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