Have you ever gone to pick up a new medicine, only to have the pharmacist tell you it needs prior authorization? It happens to many of us. Here are things you can do to avoid leaving empty handed.

When you receive a new prescription, ask your doctor if your it needs prior authorization from your insurance company. Only a handful of prescribed drugs need prior authorization. If the answer is “yes”, your doctor’s office should handle requesting it.

If the request is approved, you'll only pay your share for the drug. Your prescription drug benefit will cover the remaining cost. If the medicine doesn’t receive prior authorization, you’ll have to pay the full cost. Your prescription drug benefit won’t cover any of the drug’s cost.

If a prior authorization is denied, ask your doctor if a generic version or other drug might be right for you.

Why Is Prior Authorization Important?

Prior authorization helps promote safe and effective use of medicines. It is a way for your doctor and insurance company to make sure your drug is being prescribed, managed and taken safely.

Before you go to the pharmacy, follow these tips:

• Ask your doctor if a new prescription needs prior authorization.
• Look up your drug on Blue Access for Members^SM or the BCBSNM App and go to your Dashboard. Look for Pharmacy. If your drug needs prior authorization, a notice will appear. You can get the status on prior authorizations, also called clinical reviews.
• You can also log in to MyPrime website,  your pharmacy benefit manager website, by searching the Find Medicine section. You can get notices for when prescription drugs need prior authorization and more info about the process.

When your prescription is authorized, it is approved for a limited time, usually six months or up to a year. You won’t need to submit a new request with every prescription refill. Before the prior authorization runs out, you may get an alert.

MyPrime.com is a pharmacy benefit website offered by Prime Therapeutics LLC.