Medication Prior Authorization: $25.00

Most medications I use are available in a generic, cost-saving preparation. Occasionally, however, I may recommend certain newer, brand-name only medications that are costly enough that your insurance company--if you are using medical insurance at the pharmacy--will require prior authorization before agreeing to pay for it.

This involves explaining to the insurer why the medication is being prescribed, including justifying the amount; there are often limits as to the quantity of pills that can be dispensed over a certain period of time. It is a purely financial concern on the part of your insurance company, but in addition to your identifying information and basic demographics, the diagnosis/indication must be verified and approved, and other details about your treatment at SPC are released. In many cases, the insurance company requires documentation of outcomes of prior trials using other, less expensive FDA-approved medications.

The prior authorization protocol is a time-consuming process that involves registering the request, submitting and resubmitting forms, and answering surveys. It can take several business days to process and be approved (sometimes with automatic expiration/review dates, for periods of one year at a time), unless an expedited review is requested, but delays of 1-2 days are commonplace, and there is always the remote possibility that your insurance company will reject the prior authorization request altogether.

There is a nominal, one-time $25.00 surcharge for this service; if it has to be reviewed annually, you will not be charged again the following year. Additionally, if you pay this surcharge and we switch medications and another prior authorization is required by your insurance company within the same calendar year, you will not be charged again; you will only be charged, at most, once per calendar year for any and all prior authorization requests.

Please bear in mind that you might get a better price on your refills using GoodRx or the Kroger Prescription Savings Program, or similar grocery-store pharmacy discount programs, compared to obtaining prior authorization and then paying your top-tier pharmacy insurance copay. Many grocery stores offer free prescription discount programs, or everyday low prices on medications, and prices at HEB, Walmart, Target, Kroger, etc. are always much more reasonable than prices at franchise convenience-store pharmacies like CVS and Walgreen's. The best prices are often found using the free GoodRx app, which provides price listings for medications from stores in your area which you can easily compare.