Urgent review of pharmacy PA requests

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

“Urgent” prior authorization requests will be completed as soon as possible, taking into account the medical exigencies, but no later than 24 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 is clearly marked as such. Another option is to call the Pharmacy Department directly to notify us that a request requires urgent review.

All other non-urgent prior authorization requests will be completed within a reasonable period of time appropriate for the medical circumstances, usually within 48-72 hours, but not later than 15 calendar days following the receipt of the request.

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