Home < Human
Resources and Benefits Briefing < January
2006
Beginning in 2006, the Core Plan for retirees with Medicare will include a program which most other UC medical plans already have in place: prior authorization for certain prescription drugs. Some prescription drugs under UC-sponsored medical plans require prior authorization in order to be covered.
Request process
Prior authorization for prescriptions is used by medical plans to ensure the proper use of drugs that are at risk for inappropriate use, prescribed in ways that fall outside FDA-approved indications, or are high in cost. Typically, the physician prescribing the medication is asked to provide the prior authorization, but in some circumstances the patient is responsible for submitting the request to the health plan.
Requests for prior authorization are generally submitted on forms which are available from your health plan. Your doctor should complete the prior authorization form and submit it to the health plan. Most prescriptions that require prior authorization can be approved within 24 hours; however, some may take longer. Therefore, it is important to communicate with your physician regarding your needs to ensure timely receipt.
Plan formulary
If you have questions about a particular drug, check with your medical plan directly. You may also refer to your plan’s formulary to verify if prior authorization is required. UC-sponsored medical plans use a drug formulary (a list of drugs developed by your health plan to identify which medications are sound, therapeutic, and cost effective) to help your doctor make decisions about prescriptions.
Helpful Hints for Prior Authorization:
- Take a copy of your medical plan’s formulary and/or prior authorization list with you when you visit the doctor
- If a medication your doctor prescribes require prior authorization, have your physician log on to your medical plan’s website to get the required form and complete it while you’re in the office
- Have your doctor’s office fax the form to your medical plan and follow up as needed
- If your prior authorization is only approved for a certain amount of time (most are not approved for more than one year), plan ahead to ensure your physician begins the process again before you run out of medication
Telephone numbers and internet links for each medical plan are available on At Your Service (atyourservice.ucop.edu; select Contact List.)
