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Prior Authorizations
 
Your doctor must complete a form and return it to us before the prescription can be filled.

Some prescriptions must be approved before you can get them filled. This is called a prior authorization. If a medicine needs prior authorization, your doctor must complete a form and return it to us before the prescription can be filled.

If the request is approved, a notice is sent to your doctor, and you can get your medicine. If the request is denied, you will get a letter explaining why. If you don't agree with the denial, you can appeal the decision. To file an appeal, call Member Services at 888.276.2020.

To avoid this, ask your doctor if the medicine requires prior approval when your doctor gives you the prescription. Most medications do not require prior approval; ask your doctor if there is one that would work for you.

Also, while you are waiting for a drug to be approved, you might be able to get a temporary supply of the medicine.

If you have any questions about prior authorizations, please call Member Services at 888.276.2020.