APPARATUS AND METHOD FOR PROCESSING PRIOR AUTHORIZATIONS FOR PRESCRIPTION DRUGS

摘要

Provided is a method and apparatus for preparing a request for prior authorization of coverage for a prescription drug. After a previous claim requesting at least partial coverage of a cost associated with the prescription drug has been submitted, a notification that prior authorization of the at least partial coverage has been required by the benefits manager is received. After receiving this notification, the method involves automatically conducting a query of a computer-accessible database to retrieve information included in a previously-submitted request for prior authorization. The information retrieved is presented to be confirmed as suitable for submission in the request for prior authorization as part of a current transaction and, in response to receiving confirmation that the information presented is suitable for submission as part of the request for prior authorization during the current transaction, transmitted to at least one of a prescriber for approval and the benefits manager.

主权项

1. A method of preparing a request for prior authorization of coverage for a prescription drug, the method comprising:
receiving, with a computer system after a claim requesting at least partial coverage of a cost associated with the prescription drug has been submitted to a benefits manager, a notification that prior authorization of the at least partial coverage has been required by the benefits manager; after said receiving the notification that prior authorization has been required, automatically conducting a query of a computer-accessible database to retrieve information included in a previously-submitted request for prior authorization; presenting the information retrieved from the previously-submitted request for prior authorization to be confirmed as suitable for submission in the request for prior authorization as part of a current transaction; and in response to receiving confirmation that the information presented is suitable for submitting in the request for prior authorization as part of the current transaction, transmitting the request for prior authorization to at least one of a prescriber for approval and the benefits manager.