[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283991-105":53,"doc-detail-283991-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","optumrx-prior-authorization-how-to-determine-and-complete-a-pa","OptumRx Prior Authorization - How to Determine and Complete a PA","","Prior authorization (PA) requires a member’s doctor to provide reasons for a prescribed medication so it can be covered under the pharmacy benefit. Certain drugs need review due to safe treatment of specific conditions or higher cost compared with similar options. The document explains how to check PA needs at a pharmacy, online through Optum Rx member tools, or by contacting Optum Rx. It also covers submission timelines, approval or denial notifications, appeal steps, and why additional clinical information is requested.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/optumrx-prior-authorization-how-to-determine-and-complete-a-pa/283991/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/optumrx-prior-authorization-how-to-determine-and-complete-a-pa/283991.png","ImageObject",442,249,{"name":88,"@type":89},"Himbo","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":35},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is prior authorization (PA) and why is it required?","Question",{"text":108,"@type":109},"Prior authorization requires your doctor to explain why you are taking a medication so it can be evaluated for coverage under your pharmacy benefit. Some drugs require review due to specific safety or effectiveness needs, or because they cost more than similar options.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How can I find out if my medication requires a PA?",{"text":113,"@type":109},"Ask your pharmacist when filling a new prescription. You can also check online in Optum Rx by going to Member tools and then using Drug pricing and information to see a coverage alert if PA is required.",{"name":115,"@type":106,"acceptedAnswer":116},"What happens if my PA request is denied, and can I appeal?",{"text":117,"@type":109},"Optum Rx sends a letter explaining why the PA was denied and provides appeal information. Your provider needs to fax a letter of medical necessity to Managed Pharmacy Consultations, and the appeal review typically takes about 24–48 hours.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},283991,1790334562,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":35,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Prior Authorization  \nWhat is a prior authorization?  \nPrior authorization (PA) requires your doctor to tell us why you are taking a medication to determine if it will be covered under your pharmacy benefit. Some medications must be reviewed because they may:  \n• Only be approved or effective for safely treating specific conditions  \n• Cost more than other medications used to treat the same or similar conditions  \nHow can I find out if my medication requires PA?  \nAtthe pharmacy  \nWhen you fill a new prescription, your pharmacist will tell you if a PAis required.  \nOnline  \nLook online to see if your medication has a PA.  \n• Log [into](into optumrx.com)[ optumrx.com](into optumrx.com) > Member tools  \n• Click on Drug pricing and information  \n• Enter the drug name and dose  \n• If the drug/dose you entered needs a prior authorization, you will see an alert below the drug name.  \nCoverage alert  \nThis drug requires a prior authorization from your provider. Please contact your provider to complete. If the prior authorization is approved, the actual price you pay may be different than the price listed.  \nOn the phone  \nCall Optum Rx at 1-866-441-2422.  \nWhat do I do if my medication needs a PA?  \nTo begin the PA process, you can:  \n• Let your doctor know that a PA is needed for your medication.  \n• Call Optum Rx at 1-866-441-2422.  \nHow long does it take for a PAto be approved or denied?  \nOnce your PA has been submitted and received, it usually takes up to 24 hours to process. If your PA request needs additional review, it may take longer. If your doctor submits a PA request electronically, they may receive approval within minutes of submitting the request.  \nHow do I know if my medication has been approved for coverage?  \nOnce we review the information from your doctor, we will send a letter to you and your doctor letting you know if your medication coverage is approved or denied.  \n• Check the status of your PA by signing [into](into optumrx.com)[ optumrx.com](into optumrx.com) > Benefits and claims >  \nPrior authorization or exception request. You will see the status of any active PAs in process.  \n• If your medication is approved, the PA is entered and coverage will be provided under your benefit. You can continue to fill your prescription at the pharmacy as usual during the approved PA period. Depending on your benefit plan and medication, you may be able to save money by using home delivery from Optum.  \n• If your medication is denied, we’ll send a letter telling you why and provide information about the appeal process.  \nCan I file an appeal if my PA is denied?  \nYes, you can appeal the decision. Your provider will need to fax a letter of medical necessity to: Managed Pharmacy Consultations at 561-209-5822.The appeal review takes about 24-48 hours. After 48 hours, members can call Optum Rx at 866-441-2422 to check the status.  \nWhy is Optum Rx questioning my doctor’s choice of medication for me?  \nWe want to make sure that coverage and costs align with the effectiveness of the medication you have been prescribed. If your medication needs a PA, that means we need more information from your doctor before deciding if your plan should cover the medication. If we don’t get this information from your doctor or your PA is not approved, we may not cover the medication.  \nOptum Rx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products.  \nWe are an Optum® company — a leading provider of integrated health services. Learn more at [optum.com](optum.com).  \nAll Optum trademarks and logos are owned by Optum, Inc., in the U.S. and other jurisdictions. All other trademarks are the property of their respective owners.© 2025 OptumRx, Inc. All rights reserved. WF15222219 112624","cbCaifmC3QNZPWgW","https://ap.wps.com/l/cbCaifmC3QNZPWgW","pdf",81261,"English","# Prior authorization basics\n## How to determine whether a medication requires PA\n## What to do when PA is needed\n## Approval or denial timelines and notifications\n## Coverage approval, denial, and appeals\n## Why Optum Rx requests additional information","[{\"question\":\"What is prior authorization (PA) and why is it required?\",\"answer\":\"Prior authorization requires your doctor to explain why you are taking a medication so it can be evaluated for coverage under your pharmacy benefit. Some drugs require review due to specific safety or effectiveness needs, or because they cost more than similar options.\"},{\"question\":\"How can I find out if my medication requires a PA?\",\"answer\":\"Ask your pharmacist when filling a new prescription. You can also check online in Optum Rx by going to Member tools and then using Drug pricing and information to see a coverage alert if PA is required.\"},{\"question\":\"What happens if my PA request is denied, and can I appeal?\",\"answer\":\"Optum Rx sends a letter explaining why the PA was denied and provides appeal information. Your provider needs to fax a letter of medical necessity to Managed Pharmacy Consultations, and the appeal review typically takes about 24–48 hours.\"}]","OptumRx Prior Authorization - How to Determine and Complete a PA | PDF",1789624017]