Insurance companies sometimes require prior authorization before they are willing to pay for a prescription. This simply means they are requesting information about your treatment to determine if a medication, its quantity, or a specific brand is necessary to your care.
Due to formulary changes made by many insurance companies, certain co-pays have increased this year. If your co-pay has increased significantly, please contact your insurance company to confirm if your payment portion has increased or if your prescription needs a prior authorization.
If you need a prior authorization, please have your pharmacy fax the appropriate form to our prior authorization department at (405) 752-9650. You must leave your prescription at the pharmacy in order for the pharmacist to fax this request. Our office is only made aware your prescription needs a prior authorization by receiving this form. Once this form has been received, we will complete the form, attach any necessary medical records, and submit all information to your insurance company. Due to high volume during the months of January and February, this process may take up to 5 business days. This information is NOTsent to your pharmacy.
Once your insurance company has received this information, it may take up to 72 hours for them to process it and make a determination. Appeals can take up to 1 month to be processed. After a determination has been made, your insurance company will call or mail you a letter to inform you of their decision. Most insurance companies will not cover the medication Buprenorphine for pain management. Please contact your insurance company to check your prior authorization status. If a prior authorization is denied, it is the patient’s responsibility to pay for the prescription out of pocket.
Prior authorization is valid for up to 1 year, depending on your insurance, and cannot be initiated until your prescription has been denied by the insurance company.