Frequently Asked Questions: Prior Authorization Updates from CoverMyMeds

You and your healthcare team signed up for prior authorizations when they submitted required prior authorization form through the CoverMyMeds platform.

A prior authorization (or prior auth) request is a process requiring pre-review of your doctor’s prescribed medication before insurance coverage can be provided. Through the prior authorization process, your doctor informs your insurance plan why you need this exact medication and why it should be covered.

Prior authorization is a tool used by insurance plans to make coverage determinations and to verify clinical decisions of healthcare providers. When prior authorization is required for a prescription medication, providers must fill out a request form and send it to the payer/pharmacy benefit manager (PBM) for a determination.

The patient can expect insurance coverage for the medication only after the prior authorization request receives an approval determination from the health plan. For denied prior authorization requests, determinations can be appealed by healthcare providers for another chance at coverage – otherwise, a different medication must be prescribed, or the patient must pay for the medication out of pocket.

Based on your coverage, your insurance plan requires a prior authorization request to be submitted for a medication you were recently prescribed. A prior authorization request allows your prescriber to confirm that you need this exact medication based on lab ranges, treatment steps taken or other factors, and gives the insurance plan more context as to why it should be covered.

If you received a text or email notification from CoverMyMeds, click the link provided to find the outcome of your prior authorization.

During the completion of the prior authorization request, your provider will opt you into this service with your approval. While doing so, you will indicate whether you want to be notified via text message or email.

Once the outcome of the prior authorization is received from the insurance company, we will simultaneously notify both you and your provider of the outcome.

To opt out of text messages, you can respond OUT or STOP to messages at any time. If you opted in via email, you will need to contact our network services team to opt out. For tech support, you can contact the network services team for help at 866-747-4276 Monday – Friday 9 AM - 5 PM ET.

It is important to note that notifications are not available for every prior authorization, so healthcare providers may not have the option to sign you up for notifications when submitting a prior authorization request for certain medications. For qualified therapies, your healthcare provider can follow these steps:

1. Your healthcare provider will start a prior authorization request at covermymeds.health or open a pharmacy-initiated request.
2. With your consent, your healthcare provider can select an option on the prior authorization request page to inform you of your prior authorization outcome.
3. Your healthcare provider will enter your preferred contact information.
4. Your healthcare provider will send the prior authorization request to the plan. Once the plan determination is received, both you and your healthcare provider’s office are notified.

CoverMyMeds, part of McKesson Prescription Technology Solutions, is one of the fastest growing healthcare technology companies in the U.S. and consistently recognized as one of the best places to work in the country. CoverMyMeds’ solutions connect the healthcare network and help patients get the medications they need to live healthy lives, increasing speed to therapy and reducing prescription abandonment. Our network includes more than 500 electronic health record systems (EHRs), 50,000 pharmacies, 900,000 providers and most health plans and PBMs. CoverMyMeds solutions work for all drugs and all health plans and PBMs, including Medicare Part D, Medicaid and specialty medications. Our electronic services, including prescription decision support, electronic prior authorization (ePA)and specialty support services are available at no cost for providers, pharmacists and their staff.