Obtaining Prior Authorization

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Prior Authorization

Steps in Obtaining Prior Authorization for Prescription Drugs

A Prior Authorization must be obtained by your physician before you can receive plan coverage for medications we have identified as Prior Authorization (PA) on our formulary.

Drug(s) identified at physician's office as requiring prior authorization:

Physician calls the number on the back of your ID card.
Physician indicates they are prescribing a medication that requires prior authorization.
Physician is connected to the appropriate area and is instructed on the information necessary for prior authorization.
Coventry Health Care will call the Physician's office with approval/denial (review process takes 24-48 hours*)
Physician's office will notify you of outcome.

Drugs identified at the pharmacy as requiring prior authorization:

Pharmacist instructs you that the drug requires prior authorization.
You call the number on the back of your ID card.
You indicate you have been prescribed a medication that requires prior authorization.
You give your physician's name, phone number, and the medication requiring authorization to Coventry Health Care.
Coventry Health Care will call the Physician requesting appropriate information.
Coventry Health Care informs the pharmacist with approval/denial (review process takes 24-48 hours*).
Pharmacy calls you back with outcome.

*Please note that drugs listed as requiring prior authorization, step therapy and quantity limits are not drugs that would be used in life threatening situations. You always have the right to obtain the medication and pay out-of-pocket without waiting for an approval or denial. If the drug is approved, you can submit a claim for reimbursement, minus any applicable copay/deductible.