What is a Prior Authorization in Medicare Part D?

A Medicare Part D Prior Authorization (PA) is a form of Coverage Determination that applies to a specific medication under a Part D prescription drug plan. A Prior Authorization requires you and your doctor or other prescriber to obtain approval from your Part D plan before it will cover a specific medication.

Prior Authorizations usually require your doctor or other prescriber to submit a request stating the medical necessity for prescribing the drug. If the Prior Authorization request is approved by your plan, your medication will be covered. If not approved, you may either submit an Appeal asking your plan to reconsider its decision, pay the entire cost of the medication or ask your doctor or other prescriber to prescribe an alternate drug covered by your plan.

Return to the Medicare FAQ section to view more answers to other commonly asked questions about Medicare prescription drug coverage.