Prior Authorizations
A prior authorization (PA) review is used for a wide variety of medications to confirm that medication is being prescribed for its intended use based on FDA guidelines. These reviews are meant to ensure certain prescriptions meet specific criteria before they are covered by a pharmacy plan. This process helps manage the safe and cost-effective use of medications.
Quick Links Available for Members & Their Providers
PA Form Download – For Members and Prescribers
To initiate a PA, download the PDF and complete the information requested. If you are the member completing the form, you will need your prescriber to provide a signature before submitting the application.
Submit a completed PA Form on Behalf of a Patient
If you are a prescribers office, the prescribing physician/nurse, or pharmacy and need to submit your patient’s completed PA form, launch the Prompt PA portal below to begin processing.
RxBenefits Protect Members Check Your PA Status
Check for real-time status updates of your PA request through the member portal if your plan is apart of RxBenefits Protect. Reach out to your company’s benefits administrator if you are unsure if you have access to this service.
Member FAQs
Before a GLP-1 medication is dispensed to you, it may have to undergo a prior authorization (PA) review. These reviews are used for a wide variety of medications to confirm that the medication is being prescribed for its intended use based on FDA approval guidelines and standards of care.
If your plan requires a PA for GLP-1s approved for Type 2 diabetes, you won’t be able to fill your GLP-1 prescription immediately. If this happens, call your prescribing doctor and let them know your medication requires a PA – they’ll need to file paperwork for your prescription to confirm a Type 2 diabetes diagnosis. If your plan covers GLP-1s approved for weight management and requires a PA for them, your doctor should file PA paperwork confirming a diagnosis related to weight management.
Your prescription will be approved or denied based on the information your doctor provides, and you’ll be notified of the decision by mail.
View or download this flyer to understand GLP-1 drugs, shortages, and coverage.
If you have a question about your PA, log into your member portal to check the status or use the chat feature to contact the customer care team during business hours.
Below are additional methods for contacting customer care.
Telephone Number: 800.334.8134
Email: customercare@rxbenefits.com
Hours of Operation: 7:00 am – 8:00 pm Monday – Friday CST; Closed – Saturday & Sunday
Appeal instructions are always included in the denial notification.
Each PA time varies due to a number of factors. An initial PA can take up to 7 business days to process.
Providers can access PromptPA for status updates, even if they did not submit/initiate the PA in PromptPA. They just need the Member ID Number, Member Name, Date of Birth, and EOC# to check status. Members can check the status of their PA by logging into their member portal.
