“Smart” prior authorizations for medications save you time.

Send the Rx and skip the initial request

A “smart” prior authorization (PA) is an electronic prior authorization process where pharmacies review patient-specific medical data to determine if an automatic approval can be granted for a requested medication. Reviewable data in the “smart” PA system include any previously submitted medical diagnosis codes and medication therapies, as well as provider specialty.

How to save time with “smart” PAs

• 1. When prescribing a medication that requires prior authorization, simply send the prescription to the member’s pharmacy. Do not submit a PA request at this time.
• 2. The pharmacy will use the “smart” PA system to automatically determine if data available in the member’s medical records satisfy the PA requirements.

• a. If data meets PA requirements, the medication will be automatically approved and the pharmacy claim will be paid. No need to manually submit a PA request.
• b. If data does not meet PA requirements, the pharmacy will reach out to you to request that you submit a manual PA request for the claim to be paid.

The use of “smart” prior authorizations is becoming more common practice—saving providers time and improving efficiency and timeliness in patient care.