How Prior Authorization Works for Medications?

Some prescriptions—especially expensive brand-name or specialty drugs—require prior authorization before they can be filled. This means your doctor and the health plan must confirm the medication is necessary and covered.

What this means for you:

• You may experience a short delay before the prescription can be picked up.
• Your doctor’s office submits paperwork to approve the medication.
• The health plan reviews the request to make sure it’s appropriate and cost-effective.

What you should do:

• Request refills early—don’t wait until you’re out of medication.
• If you think you’ll run out before approval comes through, contact your nurse navigator at nurse@selffundhealth.com or 608-284-8831.
• Your nurse can help expedite the process and explore if there’s a $0 preferred alternative available.

Prior authorization is designed to ensure safe, effective, and affordable use of medications while protecting members from unnecessary costs.