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Prior Authorization (PA)

Some prescription drugs require prior authorization (PA) or a medical exception for coverage. If your drug requires this step, your doctor will need to request and receive approval from Simply Healthcare before the drug may be covered under your benefit plan.

Why is Prior Authorization required?

Simply Healthcare requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval from the plan before you fill your prescriptions, if you don't get approval, the plan may not cover the drug.

How do I get Prior Authorization for my prescription?

Follow the steps outlined below to receive coverage for medications requiring prior authorization:

A. If a Prior Authorization is required, ask your doctor to submit the request to Simply Healthcare by fax (1-877-577-9045) or by phone (1-877-577-9044) and include a Request for Coverage Determination Form located below.

Prior Authorization Form (English / Spanish)

B. Request for Coverage Determination Form is available under in the Part D Grievance and Appeals/Coverage Determinations page as well as above. Bring it with you to your next doctor’s office visit. Once your request has been processed, your doctor will be notified. The plan will mail you a determination notice.

Please use the links listed in this document to access the specific criteria set that applies to your plan.

 
Last Updated: 
October 1, 2018