How to Obtain Prescription Drug Preauthorization Sample Clauses

How to Obtain Prescription Drug Preauthorization. To obtain prescription drug preauthorization, the prescribing provider must submit a prescription drug preauthorization request form. These forms are available on our website or by calling the number listed for the “Pharmacist” on the back of your ID card. Prescription drugs that require preauthorization will only be approved when our clinical guidelines are met. These guidelines are based upon clinically appropriate criteria that ensure that the prescription drug is appropriate and cost- effective for the illness, injury or condition for which it has been prescribed. We will send you written notification of the prescription drug preauthorization determination within fourteen (14) calendar days of the receipt of the request. You may request an expedited review if the circumstances are an emergency. Due to the urgent nature of an expedited review, your prescribing provider must either call or fax the completed form and indicate the urgent nature of the request. When an expedited preauthorization review is received, we will respond to you with a determination within seventy-two (72) hours or less. If we deny your request for preauthorization, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal. When a prescription drug is not on our formulary, you can request that this plan cover the drug as an exception. To request a formulary exception, complete a Coverage Exception form (located on our website), contact our Customer Service Department, or have your prescribing provider submit a request for you. We will respond to you with a determination within seventy- two (72) hours following receipt of the request. For standard exception reviews, if the exception is approved, we will cover the prescription drug for the duration of the prescription, including refills. You may request an expedited review if a delay could significantly increase the risk to your health or your ability to regain maximum function, or you are undergoing a current course of treatment with a drug not on our formulary. Please indicate “urgent” on the Coverage Exception form or inform Customer Service of the urgent nature of your request. We will respond to you with a determination within twenty-four (24) hours following receipt of the request. For expedited exception reviews, if the exception is approved, we will cover the prescription drug for the duration of the exigency. For both standard and expedited exception reviews, if we grant your r...
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How to Obtain Prescription Drug Preauthorization. Prescription drug preauthorization is required for certain brand name prescription drugs and Specialty Prescription Drugs. To obtain Prescription Drug Preauthorization, the prescribing provider must submit a completed Prescription Drug Preauthorization request form. The prescribing provider may obtain a Prescription Drug Preauthorization form by visiting our Web site at XXXXXX.xxx or calling the Physician and Provider Service Center. Preauthorization requests may be submitted in one of the following ways:  by fax, submit the form to Catamaran at 0-000-000-0000;  by phone, contact Catamaran at 0-000-000-0000; or  by mail, send the completed form to: Catamaran Prior Authorization P. O. Box 5252 Lisle, IL 60532-5252 Prescription drugs that require Prescription Drug Preauthorization will only be approved when our clinical guidelines are met. The guidelines are based upon clinically appropriate criteria that ensure that the prescription drug is appropriate and cost-effective for the illness, injury or condition for which it has been prescribed. We will send to you written notification of the Prescription Drug Preauthorization determination within two (2) business days of receipt of all medical documentation required to conduct the review, but not to exceed fourteen (14) calendar days from the receipt of the request.
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