What Does Prior Authorization Mean for Medication?

When it comes to navigating the healthcare system, one term that frequently arises is “prior authorization.” This term may sound complex, but its meaning is integral to the healthcare process. So, what does prior authorization mean for medication?

Understanding Prior Authorization

In simple terms, prior authorization, or preauthorization as it is often called, is a requirement that your physician obtains approval from your health insurance plan to prescribe a specific medication for you. This ensures that the prescribed medication is covered under your insurance policy before you actually get the medication. The intent behind this is to confirm that the medication is medically necessary and is the most cost-effective treatment available.

The Importance of Pre Authorization

Understanding search intent, in this case, means understanding why prior authorization is important. Prior authorization acts as a checkpoint in the healthcare system. It keeps healthcare costs under control by ensuring that expensive drugs are prescribed only when necessary. This not only helps in controlling insurance premiums but also reduces out-of-pocket expenses for patients.

The Authorization Process

The prior authorization process typically involves your physician submitting a request to your insurance company for approval. This request includes clinical information and justification for the prescribed medication. The insurance company reviews this request and tries to reach a verdict on whether the medication is medically necessary, or no cheaper generic version can be used in its place, and is covered under your policy. This process can take anywhere from a few days to a few weeks.

Consequences of Not Obtaining Prior Authorization

If preauthorization is not obtained, there can be serious consequences. The cost of the medication may not be covered by your insurance, leaving you to bear the entire cost out-of-pocket. This is why it’s crucial to ensure that your healthcare provider has obtained the necessary authorization before you pick up your prescription.


The world of healthcare can be confusing, with terms like ‘pre authorization’ adding to the complexity. However, understanding these terms can help patients navigate the system more effectively. It can also help healthcare providers get a clearer picture of the cost of a treatment plan, and often prevent the need to chase patients for pending copays or out-of-pocket expenses. Prior authorization for medication is a vital part of this system, ensuring that treatments are both medically necessary and cost-effective.

On a concluding note, it is always advisable to remember that if you’re ever unsure about any aspect of your medication or insurance coverage, it is always best to ask your healthcare provider or insurance company directly. They can provide you with the most accurate and up-to-date information, and help prevent unpleasant surprises afterwards.