Have you ever gone to pick up a new medicine, only to have the pharmacist tell you it needs prior authorization from your doctor?  It happens to many of us. Here are things you can do to avoid leaving empty handed.

When you receive a new prescription, ask your doctor to request prior authorization from your insurance company.  If the request is authorized, you'll only pay your  share for the drug. Your prescription drug benefit will cover the remaining cost.  If the medicine doesn’t receive prior authorization, you’ll have to pay the full cost. Your prescription drug benefit won’t cover any of the drug’s cost.

If a prior authorization is denied, ask your doctor if a generic version or other drug might be right for you.

Why Is Prior Authorization Important?

It helps promote safe, cost-effective use of medicines. Only a handful of prescribed drugs (the most costly and often misused) need prior authorization. It is a way for your doctor and insurance company to make sure you are taking the drug safely.

Before you go to the pharmacy, follow these tips:

• Ask your doctor if a new prescription needs prior authorization.
• Look up your prescription drug on the MyPrime website.
• Visit Blue Access for Members^SM (BAM):
  • Select Prescription Drugs in the Quick Links box.
  • On MyPrime, search the “Find Medicine” section.

Note:  If your prescription drug needs prior authorization, a notice will appear.

When your prior authorization is approved, it is approved for a limited time, usually six months or up to a year. You won’t need to submit a new request with every prescription refill.  Before the prior authorization runs out, you will get an alert.  The alert is sent by letter, but you can sign up for email or text alerts on MyPrime.com.  Simply go to  “Communications Preference” on your profile to set them up.

Originally published May 26, 2015; Revised 2019, 2021