Prior authorization for prescription drugs: what you need to know

Prior authorization for prescription drugs: what you need to know

November 4, 2020

Prescription medications sometimes need prior authorization (PA) to determine if the HealthSelectSM Prescription Drug Program (PDP), administered by OptumRx, can cover them. Some medications must be reviewed because they may:

  • only be approved to treat specific conditions or
  • cost more than other medications used to treat similar conditions.

pharmacist hand extending from mailbox holding prescription drugsThe PA review process happens between your doctor and OptumRx. If your medication requires a PA, your doctor must tell OptumRx why you need to take the medication so OptumRx can determine if the medication is covered under your PDP benefit. After OptumRx reviews the information from your doctor, OptumRx will send a letter to you and your doctor to confirm or deny coverage.

How to find out if your medication needs a PA

You can find out if your medication needs a PA in one of the following ways:

  • At the pharmacy: When you go to your preferred pharmacy to fill a new prescription, your pharmacist will tell you if a PA is required.
  • In the mail: If a PA is a new requirement for a medication, OptumRx will send you a letter.
  • Online: You can visit www.healthselectrx.com/ to see if your medication needs a PA. Click on the Drug Pricing Tool, then enter the prescription drug name and dose.
  • On the phone: Call OptumRx toll-free at (855) 828-9834 (TTY: 711).