In the ever-evolving landscape of healthcare, accessing specialized medications can be crucial for managing certain medical conditions. In 2023, we’ve worked closely with carriers to identify the top 5 special authorization drugs that might be essential for your health and well-being. Let’s explore some of these medications and the steps you need to follow to access them.

Top 5 Special Authorization Drugs/Drug Supplies for 2023 and Common Therapeutic Use:

Botox – Migraines

Ozempic – Diabetes

Freestyle Libre – Diabetes Supplies

Ajovy – Migraines

Truvada & Its Generics – HIV/Prophylaxis

Understanding Special Authorization:

Special authorization drugs are medications that require an additional review and approval process before they are covered by your insurance plan. Here’s a step-by-step guide on how to access these vital medications:

Denial at the Pharmacy

When you visit your pharmacy to obtain a special authorization drug, if approval is not already in place, your claim may be denied, with a notice stating that special authorization is required.

Physician’s Involvement

At this point, you’ll need to involve your physician. They will be required to fill out a Special Authorization form for review.

Accessing Special Authorization Forms

If you are set up online through your insurance carrier, you should be able to find the necessary special authorization forms on your member portal. These forms are typically available in the ‘Prescription Benefits’ or ‘Medication Coverage’ section. Many websites also contain a feature to look up and determine if a drug requires special authorization.

Contacting the Carrier

In cases where you cannot find the required forms on your member portal, don’t worry. You can easily obtain them by reaching out to your insurance carrier. You can do this through phone, email, or virtual chat. The carrier’s customer service team will assist you in acquiring the necessary forms.

Submitting the Special Authorization

Once you have the special authorization form, follow the instructions provided on the form for submission. Typically, this will involve completing the form with your physician and sending it to the designated address or email for review.

It’s important to note that the approval process for special authorization drugs may take some time, so it’s advisable to initiate this process well before your current medication supply runs out. Timely communication with your physician and the insurance carrier can help streamline the process.

At Navigate Benefit Solutions, we understand the importance of accessing the medications you need for your health and well-being. If you have any questions or require assistance with the special authorization process, please don’t hesitate to reach out to our dedicated team. Your health is our priority, and we’re here to support you every step of the way.