Medication Access Services

Prior Authorizations Guide

Clear answers and step-by-step support for getting your medications covered.

What is a Prior Authorization?

A prior authorization, also known as prior approval, is used by insurance companies to ensure that a medication filled at the pharmacy can be covered.

The health care provider and/or pharmacy submits clinical information on the need for the prescription. Without a prior authorization approval in place, the insurance company will not pay for the medication.

Why is a Prior Authorization sometimes needed for certain medications, treatments, or services?

  • Prior authorization is a way for the insurance company to determine if the requested use of the drug is clinically justified and/or cost-effective.

  • Insurance companies decide whether drugs are clinically needed based on FDA-approved uses, published guidelines, and/or published medical studies. 

  • Prior authorization is typically required for medications that are brand name only or other medications with no generic products available

How are Prior Authorizations completed at UC Health?

Prescriptions for medications that need Prior Authorization are sent from the prescribing provider to a UC Health Pharmacy.

The UC Health Prior Authorization team is alerted, and they submit clinical details from the electronic medical record to the insurance company. Once the insurance company decides to approve or deny the requested medication, the pharmacy team lets the patient know the outcome and next steps.

  • If the request is approved: The pharmacy will fill the prescription and notify the patient when the medication is ready.  If the patient would like the medication delivered to their home, the patient should contact the pharmacy to arrange delivery options.

  • If the request is denied: The prescribing provider may have to appeal the decision with additional clinical details not previously documented in the chart or decide on a different treatment plan. Alternatively, the patient may choose to forgo insurance coverage and pay for the medication out-of-pocket.

How long does it take to get a Prior Authorization approval?

The turn-around time is at least one (1) business day, although some requests may take longer.  Insurance companies process prior authorization requests Monday through Friday during normal business hours.

UC Health Pharmacies: 

Advantages of using UC Health Pharmacies

  • Integrated communication with providers
  • Stock medications not routinely stocked in retail pharmacies
  • Access to expansive medication access team
  • Fast turnaround times and prescription delivery service available

Prescription Delivery Service

The UC Medical Center – Hoxworth Pharmacy can deliver most prescriptions to the patient’s home.  Prescriptions may either be delivered via courier service or UPS at no additional charge to the patient.  Controlled substance prescriptions require a signature upon delivery. If you want your prescription delivered, contact the Hoxworth Pharmacy and the team will set this up.

UCMC Hoxworth Pharmacy

Phone: 513-584-8828

Fax: 513-584-5270

Email: UCMCOutpatientpharmacy@uchealth.com

Prescription Transfer Process

If the UC Health Pharmacy is unable to fill your medications as a requirement of your insurance plan or unable to get your medication to you in a reasonable amount of time.  The process to transfer a prescription is to have the desired pharmacy call the UC Health Pharmacy to request the transfer on your behalf.

For additional assistance, follow our Prescription Transfer Guide.

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