A coverage review (also called prior authorization) simply means that more information is needed to see if your plan covers a medication. This review makes sure you’re getting a medication that is prescribed for its intended use and covered by your pharmacy benefit.
Express Scripts works with doctors and pharmacists to determine which newly approved and existing medications are effective. Your plan uses this information to determine which medications are covered.
After Express Scripts receives a prior authorization request, then a review begins. Only your doctor can provide the necessary information for a coverage review. The review can be approved, denied or withdrawn.
You can check the status of a coverage review by logging in and going to Prior Authorizations under Prescriptions.
To help avoid a coverage review, ask your doctor if they’re connected to Real-Time Prescription Benefit; so they can check if your medication is covered by your plan before you try to fill it. You can also use your online account or our mobile app to check pricing and coverage.