Evaluates and authorizes approval of prior authorization pharmacy requests from prescribes received by telephone and/or facsimile using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, and/or pharmacists.
Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician’s office staff, medical management staff, and/or pharmacists.
Researches, resolves, and documents prior authorization outcomes in the pharmacy system.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Researches, resolves, and documents physician or client inquiries and grievances. Provides verbal or written results to client, prescriber, provider, and/or management.