Once a prior authorization request is submitted, what should happen next if a review needs to be completed?

Once a prior authorization request is submitted, the appropriate next step is for the request to be routed to the PA department, where it will be assigned to either a pharmacy technician or a pharmacist for further assessment. This process is crucial because trained professionals in the PA department will evaluate the request based on pre-established criteria, assessing medical necessity, completeness of the request, and adherence to clinical guidelines.

This routing is essential to ensure that there is an organized system in place to handle requests efficiently and efficiently address any specific criteria set by the insurance provider or drug formulary. By sending the request to a dedicated PA department, it ensures that those involved in the process have the appropriate expertise and resources to make informed decisions regarding the prior authorization.

While verifying the contact information of the prescribing physician and processing the prescription at the point-of-sale pharmacy are important steps in the overall medication dispensing process, they do not directly follow the submission of a prior authorization request. The role of the pharmacist in performing a thorough review is also critical, but that occurs after the request has been routed and assigned for review, making the routing process a foundational step in the prior authorization workflow.