Urgent review of pharmacy prior authorization requests

Priority Health has timelines in place for responding to urgent prior authorization requests. These timelines ensure all members receive appropriate, timely pharmaceutical care based on sound evidence and individual needs.

We'll complete urgent prior authorization requests as soon as possible, but no later than 72 hours following receipt of the request. For a request to be urgent, a delay in response could seriously jeopardize the life or health of a member or the ability of the member to regain maximum function, or a physician with knowledge of the member's medical condition believes that delay would subject the member to severe pain that cannot be adequately managed. If you are sending in an urgent request by fax, please make sure it's clearly marked as such. Another option is to call the pharmacy department directly at 800 942-4765 to notify us that a request requires urgent review.

We'll complete all other non-urgent prior authorization requests within a reasonable period of time appropriate for the medical circumstances but no later than 15 calendar days following the receipt of the request. In most cases, we complete prior authorization requests within 48 hours.

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