Prior Authorization &
Medication Quantity Limits
To promote appropriate use of medications by our members,
while deterring unproven or experimental uses, RegenceRx
has implemented prior authorization and quantity level limits
for select medications.
RegenceRx pharmacists and physicians check for medications
that:
- May be prone to overuse or present potential safety
issues.
- Have limited uses based on scientific studies or FDA
approval.
- May be prescribed for conditions that are not a covered
benefit.
- Require medical diagnostic tests to ensure a medical
benefit.
- Have other less expensive options.
For specific information, please refer to our RegenceRx
Prior Authorization and Quantity Limit listings.
Choose your plan from the following list:
RegenceRx Clinical Pharmacists and Medical Directors review
prior authorization requests from prescribers. We respond
in writing (usually by fax) to the prescriber, pharmacy,
and/or the member within 24 to 48 (business) hours. We also
include detailed information about the rationale if a request
was denied and educational information when available.
Quick, Automated Approvals
We’ve also established an efficient process for automating
authorizations. Claims are approved instantly when certain
criteria are met based on previous prescription claims.
This process eliminates the need for the physician to submit
information for review. By doing this, we’ve decreased
manual approvals by 25%, eliminated costs and improved customer
service.
If your patient’s medication requires prior authorization
and you’d like to know about formulary alternatives,
please refer to the Alternatives
to Non-Formulary Medications list or our RxPrice
Guide for other options.
Questions
If you have any questions about RegenceRx, contact
us. If your patients have questions about prescription
benefits, they can call Customer Service at the number on
the back of their member card, or the TTY line for people with
hearing impairments at 1 (800) 382-1003.
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