 Prior Authorization &
Medication Quantity Limits
To promote proper use of medications, 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 are used longer or in higher
quantities than are recommended.
- Have other less expensive medications that may be an
option.
- 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.
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 the member within 24 to 48 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 doctor to submit
information for review. By doing this, we’ve decreased
manual approvals by 25%, eliminated costs and improved customer
service.
If your medication requires prior authorization and you
are wondering what formulary alternatives are available,
please refer to the Preferred
Medication Alternatives list or our RxPrice
Guide for other options.
Questions
For questions about your prescription medication benefits,
please call Customer Service at the number on the back of
your member card, or the TTY line for people with hearing impairments
at 1 (800) 382-1003. We encourage you to share this information
with your physician or other medical provider. |