What Is Prior Authorization?
A prior authorization is an extra step that some insurance companies require for certain medications. If your medication requires a prior authorization, it means the insurance company needs more information from the prescribing doctor before they can decide if they want to pay for it.
Becoming familiar with the prior authorization process may enable you to get your medicine approved faster. But beware, not all medicines will be approved. Even if you do everything right, the insurance company may still refuse to cover your medicine. In the end, the insurance company is the one making the decision.
You may contact your insurance at any time to find out why your medication requires a prior authorization, how long it will take and what you can expect to pay if the authorization is approved.
The prior authorization process may need to be renewed each year, or possibly every month depending on your insurance company.
What medicines require a prior authorization?
- Expensive medicines.
- Medicines with age limits. Retin-A, a topical acne treatment, is an example. Acne is considered to be a condition of children and young adults. Retin-A may not be covered if the person is over a certain age determined by the insurance company.
- Drugs used for cosmetic reasons. For example, Propecia, which is prescribed to re-grow hair or to prevent hair loss.
- Drugs prescribed to treat a non-life threatening medical condition. An example is erectile dysfunction drugs such as Cialis.
- Brand name medicines that have a generic available.
- Drugs not usually covered by the insurance company, but said to be medically necessary by the doctor. Many different drugs can be used to treat the same condition. If a patient requires a particular medicine, the doctor must inform the insurance company that there are not any other medicines that would work for the patient.
- Drugs that are usually covered by the insurance company but are being used at a dose higher than “normal”.
What should I do if my medicine needs a prior authorization
- Contact the doctor who prescribed the medicine and let them know that your medicine requires a prior authorization.
- Ask your doctor how long it usually takes for them to contact the insurance company and fill out the appropriate forms.
- Contact your insurance company and make sure there are not any additional steps you need to take. Sometimes an insurance company may want you to fill out some paperwork or sign some forms.
- Allow the doctor’s office and insurance company enough time to complete their end of the process (usually a minimum of 3 business days once the doctor initiates the process.
- Check back with the pharmacy to see if the prior authorization was approved. If your medicine is not approved, call your insurance company and find out why.
What are some of the reasons why a prior authorization may not be approved?
- You did not give your insurance company, doctor, and pharmacist enough time to complete the needed steps.
- Your insurance denied your prior authorization claim.
- Your doctor’s office forgot to contact your insurance company.
What Is A Deductible?
Some prescription insurance plans have an annual deductible. This is the amount you must pay each year for your prescriptions before your prescription insurance begins to pay its share of your covered drugs.
Generally, when a prescription insurance plan applies a deductible, you will pay the approximate full cost of your medications until you have paid the deductible. Once the deductible is met, you will then only pay your portion or “copay” for your covered medications.
Most deductibles are annual meaning it will restart each plan year. Common plan year start dates are September 1 or January 1.
At any time, you may contact your prescription insurance plan to find out if you have a deductible, how much the deductible is, how much you have currently paid toward that deductible, and when the deductible will restart.
How Can I Pay?
Forty Acres Pharmacy accepts cash, checks, Visa, MasterCard, American Express, Discover, and Bevo Bucks.
Payment is due at the time of service. Sorry, we are unable to bill your “What I Owe” page.
Can I Use Forty Acres Pharmacy If I'm Not Enrolled Or After I Graduated?
Yes! Forty Acres Pharmacy is able to provide prescription drug services even if you are not registered for classes (in the summer, for example) and also after you graduate.
How Do I Obtain My Prescription Records?
To obtain a copy of your prescription records:
- Come to Forty Acres Pharmacy and request your records in person. Be sure to bring a valid photo ID, or,
- Complete an Authorization Release of Prescription Records and FAX your authorization form and a photocopy of your valid photo ID to 512-475-8218
How Do I Transfer A Prescription?
To transfer a prescription TO Forty Acres Pharmacy FROM another pharmacy, simply click HERE. You can also call or come by the Forty Acres Pharmacy with the medication in its bottle or package and we’ll take care of the transfer for you. Transferred prescriptions are usually ready in about one business day.
To transfer a prescription FROM Forty Acres Pharmacy TO another pharmacy, contact the other pharmacy and request a prescription transfer. They will need some of your information and our phone number: 512-471-1824
How Do I Refill A Prescription?
If the prescription was last filled at Forty Acres Pharmacy,
- Refill online
- Call in your refill to 512-471-1824
- Come to Forty Acres Pharmacy and request your refill in person.
Please Note: You will need the name of your medication and the prescription number. (Both are on the label on packaging/bottle) The pharmacy will contact your healthcare provider for instructions if your refill has run out. This may require additional time.
How Do I Fill A Prescription?
It’s easy to fill your prescriptions at Forty Acres Pharmacy. If your physician is issuing a new prescription, you should:
- Bring your prescription with you to the pharmacy or
- Request that your healthcare provider call the prescription directly to Forty Acres Pharmacy
- Be sure to bring your insurance card with you when you come to pick up your prescription.
- Most prescriptions can be filled quickly while you wait.
- All prescriptions should be picked up within seven days after the order is placed.
Generic drugs are an effective, safe, and often less costly alternative to brand name products. Learn more about Generic Drugs.