5 Tips for Submitting the Best PA Request for Your Patient

January 18, 2017  |  Ryan Druseikis

It’s a busy time of year for prior authorization (PA) and we know you’re inundated with requests. With a seemingly endless number of PA request forms to choose from, finding the correct one to use for your patient can feel daunting.

Luckily, CoverMyMeds has all of them pre-populated in our database so that you can find and submit them electronically— making this process as easy as possible. In fact, for your patients’ health plans that are integrated with CoverMyMeds there is no need for a form at all!

Follow these tips when you begin a request to make certain you’re completing the correct information to help the patient get the medication they need to be healthy:

Check the print date on your patient’s insurance card

It is important to be sure that you have the most current information for your patient’s coverage plan. You can guarantee this by checking the print date on the insurance card they provided. An old print date may mean the patient had a change in prescription coverage.

Choose the correct state

Insurance plans may operate out of one, many, or all American states; therefore, selecting a state associated with the plan is important to generate accurate results. Most often, the best state to begin with is the patient’s state of residence.

If the PA options that populate for you to choose do not look appropriate for the plan, the reason could be because the patient relocated to a different state than what is showing on their insurance card.

The BIN, PCN and Rx Group numbers are a great road map for making the correct request

The most accurate way to make the correct PA request is to utilize the BIN, PCN and Rx Group numbers located on the patient’s insurance card. These alphanumeric identifiers are used to locate a patient’s specific plan. The pharmacy also uses these identifiers to run a claim for the medication; therefore, if you do not have the patient’s current insurance card available, the patient’s pharmacy should be able to provide the correct information.

When searching for the correct request path, it is best to include all three identifiers in your search to return the most accurate results. Tip! A great way to remember how these work is to think of them as a street address: the BIN is the city name; PCN is the street name; Rx Group is the house number. Simply plug these numbers in, and we will navigate you to the right information to complete.

You can also search by the patient's health plan

It is possible to submit an accurate PA request with only the name of the patient’s health plan; however, you will want to be certain of the type of coverage the patient has (commercial, Medicare Part D or Medicaid) and include that in the search as well. The most relevant forms will populate for you to select from based on the information the patient was able to give you.

Choose the most drug-specific route available

Once the PA requests populate for you to choose from, it is important to select the one that will be most specific to the patient’s medication. For many medications, the plan may have a drug-specific form that they require for approval. Others may have one specific to the medication class. The former will populate first if they are available, but if no drug-specific or class-specific form exists for that plan, then a general request will be available for you to select.

Still have questions? We’re happy to help! Our PA experts can be reached at 866-452-5017, or via chat on the bottom right of the screen.