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.
Researches, resolves and documents prior authorization outcomes in pharmacy system.
Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician’s office staff, medical management staff and/or pharmacists.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescribe, provider and/or management.