What is a “smart” prior authorization for medications?

How electronic prior authorizations support efficiency

A “smart” prior authorization (PA) is an electronic prior authorization that pulls in patient-specific medical data to determine if an automatic approval can be granted for a requested medication. Medical data reviewed may include diagnosis codes, prior therapies, and provider specialty. If the system detects all required data, the pharmacy claim pays without the need for manual review. If data is missing, the claim rejects with messaging indicating that a manual PA must be completed.

Improving efficiency and patient care

The use of “smart” prior authorizations is becoming more common. It is important to first submit a prescription to the patient’s pharmacy before filling out a manual prior authorization form, as the electronic process may approve automatically. These “smart” authorizations improve efficiency and timeliness, ensuring patients get needed medications without unnecessary delays.