Steps to Take When Prescriptions Require Prior Authorization Or Step Therapy

Steps to take when prescriptions require prior authorization or step therapy

If you are currently taking a prescription medication that will require a prior authorization from Anthem, prior to refilling the prescription in 2008:

Step 1. Anthem will send you a letter advising you that a prior authorization is

required.

Step 2. Contact your doctor and ask your doctor to call the Anthem Prior

Authorization (PA) Center to request authorization to allow you to continue to

receive your medication. The PA Center will either approve the request

immediately or fax a form that your physician will need to complete and send

back to the PA Center.

Telephone number: 1-800-338-6180

Fax number: 1-800-601-4829

Step therapy (the requirement of using one medication prior to receiving a

step therapy medication) will also be introduced January 1, 2008, but will not

apply to current users of these medications.

Prescriptions requiring a prior authorization must be renewed annually.

If your doctor prescribes a new medication that requires prior authorization or

Step therapy:

Step 1. If your doctor is aware that your medication must meet prior authorization or step therapy criteria prior to being filled at the pharmacy, he/she

must call or fax Anthem’s pharmacy PA Center to request authorization prior to

the prescription being filled. (See Step 2 above for PA Center contact information.)

Step 2. If your doctor does not contact the PA Center prior to presenting your

prescription to the pharmacist, the pharmacist will be alerted that the prescription

cannot be filled without prior authorization. The pharmacist may call for the

prior authorization, and if approved, the prescription can be filled immediately.

Step 3. If your pharmacist does not have sufficient information, your doctor will be contacted by Anthem’s PA Center within 24 hours to request the additional information needed. You will not be able to pick up the prescription until the necessary authorization is obtained. Once the necessary information is received from your doctor, the review is usually completed within 24 hours.

Step 4. Prior to filling the prescription, call the customer service number on the back of your Anthem ID card or call your doctor’s office to obtain the results of the review. If Anthem has approved the request, you may pick up your prescription at the pharmacy. If the prior authorization or step therapy requirements have not been met, or Anthem was unable to obtain the necessary

information from your doctor, the request will be denied. Anthem will contact you and your doctor within 2 business days after all the clinical information is reviewed.

Step 5. If a request is denied by Anthem, you may appeal the decision, and you will be advised of the process when Anthem contacts you.