Prior authorization programs are most often used to help encourage the proper use of medicines. This can also help to lower the chances of unnecessary drug treatment and help contain overall health care costs.

Prior authorization is a clinical program that only applies to certain types of prescription medicines. These types are those that can be misused, overused or may not be the best choice for your health condition. Prescription medicines subject to the prior authorization program will need pre-approval before they can qualify for coverage under your pharmacy benefit plan. As always, treatment decisions are between you and your doctor.

Most commonly prescribed medicines under your pharmacy benefit plan do not require prior authorization. However, depending upon your specific benefit plan, a prior authorization program may be in effect for one or more prescription drugs prescribed by your doctor.

Your pharmacist will turn in the request for prior authorization if it is required.

Not all drug categories are included in all benefit plans. Additional categories may be added and the program may change from time to time.

To learn more or to check your medications’ requirements, visit bcbsok.com or call the customer service number on your member ID card.

Originally published 5/11/2020; Revised 2021, 2022