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Use Your Plan: Troubleshooting

Problem #4: Prior authorization is required.

Sometimes a pharmacist can only fill a prescription if your doctor has already gotten approval from your health plan. This special case is called "prior authorization" and it means that your insurance company must approve a particular medicine before insurance will pay for you to have it. If this is the problem, you can get approval if you or the pharmacist contacts the doctor who prescribed the medicine and the doctor submits the necessary information to the health insurance plan.

Problem 1

ID Card: The information the pharmacy has about your insurance doesn't match what is on your pharmacy benefit ID card.

Problem 2

Refill: It's too soon to refill the prescription.

Problem 3

Drug Interaction: The medicine was flagged because it may react badly with another medication you're taking or because of another medical condition you have.

Problem 4

Prior Approval: Prior authorization is required.

Problem 5

No Payment: Your health plan does not pay for the medicine you were prescribed.