Express Scripts Holding Company is the largest Pharmacy benefit company in United States. Its services related to pharmacy benefit management include network pharmacy claim processing, home delivery pharmacy services, benefit design consultation, drug utilization review, medical and drug data analysis for the management of drug plans. The headquarters of the company is in St. Louis Missouri. The pharmacy benefit management services are also provided for workers’ compensation insurance programs. Company has a network of retail pharmacies for the members who have some claims over pharmaceutical benefits.

What is Prior Authorization?

When the benefits over drugs is to be claimed, there are few drugs for which approval is needed that either the person is eligible to get benefits of the drugs or not. The process of getting such approval is known as prior authorization. The drugs may not be beneficial for the health therefore prior authorization saves the people from the use of those drugs.

What Kinds Of Drugs Need Prior Authorization?

  • There are few drugs which may have dangerous side effects need prior authorization.
  • Some drugs may harm the health when they are combined with other drugs.
  • Drugs which must be used for certain health conditions.
  • Some drugs can be misused, therefore prior authorization is necessary for those drugs.
  • Sometimes a cheaper drug can give better results, is prescribed to you by your doctor.

Prior Authorization For Express Scripts

Prior Authorization form of Express Scripts can be found and downloaded from the link followed mentioned at the right hand side.

  • First part of the form consists of Patient’s Information. In that section, following things are to be written;
  • Patient First Name
  • Patient Last Name
  • Patient ID#
  • Patient Date of Birth and
  • Patient Phone Number

Next section of the prior authorization form has information about the prescribe.

  • Prescribe Name
  • Prescribe DEA
  • Prescribe Phone Number
  • Prescribe Fax Number
  • Prescribe Address
  • State and
  • Zip Code
  • After that, diagnosis and ICD options will have to be filled.
  • Then it will be required to tell that which drug is requested and how much quantity for how many days it is requested.
  • If there were any another medications which were being used but did not have positive result, that will be mentioned with the reason of its failure and if there is any another important information which needs to be important to give to the pharmacist should be given as well.
  • At the end, prescribe will give his signature with the date and submit the form to the pharmacy.
  • After the completion of this prior authorization form, you should fax it to 1-877-329-3760.
  • If someone need to submit the prior authorization form online, then the following link can be visited mention below. When the link is opened, you need to enter your Pin and Password. If you do not have your Pin and Password, it can be taken by calling at this number, 800-496-5661.

Acceptance Of The Authorization

  • When the authorization form is received, its acceptance or non-acceptance is than communicated to the patient and the doctor.
  • In case of the approval of the authorization, medication coverage will be obtained which comes under the pharmacy benefit.
  • Disapproval of the authorization will also be given to the one who requires the pharmacy benefit from the pharmacy.
  • In case of nonacceptance, person have two choices. He may either get the same drugs by paying all the costs yourself otherwise your doctor may prescribe you another drug which can be used as an alternative of that drug and can be obtained under the pharmacy benefit.

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