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When you receive a new prescription, ask your doctor to request prior authorization from your insurance company. 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.
It helps promote safe, cost-effective use of medicines. Only a handful of prescribed drugs (the most expensive and often misused) need prior authorization. It is a way for your doctor and insurance company to make sure you are taking the drug safely.
Before you go to the pharmacy, follow these tips:
Note: If your prescription drug needs prior authorization, a notice will appear.
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 will get an alert. The alert is sent by letter, but you can sign up for email or text alerts on MyPrime.com. Simply go to “Communications Preference” on your profile to set them up.
Originally published 8/21/2015; Revised 2019, 2021, 2023
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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