Medicare PA Forms

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.

Woman in a garden

When you need prior authorization

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**:

  • Some drugs can be dangerous when mixed with other drugs
  • Some drugs are addictive or prone to misuse
  • There are drugs that might be equally effective, but which vary greatly in price
  • Some drugs should only be used for certain health conditions

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:

  • Basic information about you
  • Your primary care physician’s name
  • A copy of your provider’s signature
  • Information about the prescription drug, including the dosage

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.

Other considerations

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.

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.