What action must be taken to obtain prior authorization for a medication?

To obtain prior authorization for a medication, it is essential to contact the insurance company for approval. This process typically involves submitting necessary information about the patient, the medication in question, and the clinical justification for its use. The insurance company will then review this information to determine whether the medication is medically necessary and will cover its cost.

Communicating directly with the insurance company is critical because they have specific protocols and criteria for approving or denying requests for coverage of certain medications. This step ensures that the patient's medication will be covered and helps avoid unexpected out-of-pocket expenses.

While involving the patient's healthcare provider is necessary at some point, as they often provide the required documentation or clinical rationale, the act of contacting the insurance company itself is the definitive step that initiates the prior authorization process. Filling out a claim form or dispensing the medication and billing later does not accomplish the objective of obtaining prior approval, as those actions occur after the prior authorization is established, not before.