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Prior Authorization for Prescription Drugs

PA Team

Prior Authorization Team: Courtney Delelys, Stephanie Hemphill, Tiffany Jensen, Anthony Kessler, Amy Kliss, Paula Kraft, Joanna Ornat, Stephanie McDevitt, Patty Markham, Jessica Martinez, Victoria Sacco, Alexis Wesseldine - Missing from photo: Susan Henry, Zachary McNall

The Upstate Outpatient Pharmacy Prior Authorization team is in place to help Upstate patients eliminate obstacles in obtaining their prescriptions by assisting with the prior authorization process.

After you’ve discussed treatment options with your doctor and picked a medication you can both agree on, you may find out at the pharmacy that the medication you were prescribed wasn’t pre-authorized by your insurance company! That means you might be delayed in getting your prescription filled or responsible for a much greater prescription cost.

What Is Prior Authorization for Prescription Drugs?

Prior authorization is a process that your insurance company may require before a medication is covered by a prescription benefit.  A prescriber may need to provide additional information to the insurance company before the insurance company will provide full (or any) coverage for a particular medication. Prior authorizations are very common for “specialty drugs” since these drugs are often more costly and may require closer monitoring.  This process allows the insurance company to more closely oversee the prescribing of such drugs.

Why Do Insurance Companies Require Prior Authorization?

In short, health insurance companies pre-authorize certain medications in order to keep healthcare costs low. By ensuring that your medication is medically necessary, up-to-date, as economical as possible, and isn’t being duplicated, health insurance companies can afford to provide more expensive medications to those who truly need it.

Benefits of the Upstate Outpatient Pharmacy Prior Authorization Team

The SUNY Outpatient Pharmacy has an entire team dedicated to managing the prior authorization process. These individuals have the training and specialized knowledge needed to request the right information from patients and prescribers, and then work with the insurance companies directly. This reduces “phone tag” between the insurance carriers, patients and prescribers.

Our Prior Authorization team also has the knowledge necessary to fill out prior authorization paperwork accurately and quickly. This helps ensure that patients can receive rapid access to the drugs that were prescribed.

If a patient can’t afford the cost of their medication, even with drug coverage from their insurance company, our Prior Authorization team can work with our Medication Assistance team to search for qualifying financial assistance programs from drug manufacturers and non-profits. We work together to manage this process simultaneously as we seek approval from the insurance company.

Contact us

  • Phone: (315) 464-3784 (DRUG) or toll free: (833) 713-1125 
    and select option #6 leave a voicemail for the Prior Authorization team
  • Fax: (315) 464-4221
  • Email: [email protected]