Prior authorisation (revision 2)
Old revision·11:31, 23 Dec 2024·ReaderRosalie
This is an old revision of this page, as it stood at 11:31, 23 Dec 2024, saved by ReaderRosalie with the summary clarify that coverage varies by plan and give the source for the example. It may differ substantially from the current revision, and any error it contains may since have been corrected.
| Prior authorisation | |
|---|---|
| Also called | Pre-authorisation, pre-approval |
| Decided by | The payer, not the prescriber |
| Common criteria | Body-mass index, comorbidity, prior therapy |
| Topic infobox · conventions | |
Prior authorisation is a requirement imposed by a payer that a prescription be approved before it will be covered. It is a coverage mechanism rather than a clinical one, and the decision is made by the payer against its own criteria.[1]
For incretin therapies it is close to universal where these drugs are covered at all, and the criteria commonly include a body-mass index threshold, a comorbidity, documented prior attempts at other management, and sometimes a requirement to try a specified alternative first.[1]
References
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