Medicare Advantage plans often come with prescription drug coverage. Sometimes there are simple additional steps you need to take in order to get your prescription medication filled. Here, you’ll learn about prior authorization forms, also known as Medicare PA forms.
As a precaution, Medicare Advantage plans may require that you gain prior authorization for prescription drug coverage. You can get this authorization by submitting a PA form.
These forms allow insurers to review certain prescriptions before offering coverage. The process is built on the understanding that**:
Insurers want to make sure that you’re getting the best possible treatment. Insurers also want to make sure you’ll remain safe while taking certain prescription drugs. Medicare PA forms provide an important measure of patient protection.
How it works
If your drug requires prior authorization, you’ll likely need to send a prior authorization form to your insurer. This will likely include:
You’ll need to send this information to your insurer, who will review the form and decide whether to authorize coverage for the drug.
Plans that cover prescription drugs include what’s known as a formulary. This is a list of drugs covered by your plan. Reviewing the formulary will help you understand whether you’ll need to fill out a Medicare PA form for coverage, or whether the drug will automatically be covered.
You can always talk to your physician to see whether there’s a comparable drug that doesn’t require prior authorization. Additionally, your pharmacist can assist, too.
If you have questions about how Medicare PA forms work with your specific Medicare Advantage plan, speak with a licensed insurance agent at TTY Users: 711.
Join our Medicare Advantage email series.
By clicking "Join now" you are agreeing to receive emails from MedicareAdvantage.com
Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.
**Academy of Managed Care Pharmacy, “Prior Authorization.” Published 2012. http://www.amcp.org/prior_authorization/
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.