Prior Authorization
Process requiring healthcare provider approval before certain medications can be covered by insurance.
Prior authorization (also called pre-authorization) is a process that requires healthcare providers to obtain approval from an insurance company or pharmacy benefit manager before certain medications can be covered by insurance. This process is typically required for expensive medications, specialty drugs, or medications that have specific clinical criteria. Prior authorization helps control costs and ensures appropriate medication use, but can create administrative burden and delays in patient care.
Keywords
Every Medication Workflow. Connected.
Formidable develops the systems that let healthcare organizations prescribe, sign, harmonize, and dispense — digitally and compliantly. From electronic prescriptions to FHIR interoperability, we turn complex workflows into production-ready software.