Prior Authorization (PA) is the process of obtaining advanced approval of coverage for a prescription medication. Many health plans require a PA for more expensive drugs, such as antipsychotic medications. Genoa, a QoL Healthcare Company offers PA assistance to our center partners. If a prescription is rejected due to a PA requirement, Genoa will initiate that PA for our consumers and their prescribers. We do this through our online resource provided by our partnership with a reputable third party industry source or manually.
Our online resource allows us to find and initiate the correct PA form quickly from a website. Genoa staff will train your center clinicians. The website is available 24/7/365 and does not require additional setup. This resource works with Medicare, Medicaid, and most commercial insurance plans. Genoa will complete as much of the form as possible with consumer demographics, insurance information, physician information, etc. The form then goes to the prescriber electronically via efax to be completed and submitted to the payer. The prescriber may print, complete, and fax it in or the prescriber may complete the form using our online resource and submit it to the payer electronically.
Sometimes our center partners provide us access to their Electronic Health Records (EHR) program. Many times the PA requires that the person has tried and failed a certain number of other drugs in a category (step therapy) before it will be approved. If we can look that information up on the clinic's EHR program, some payers will allow us to complete the entire PA without even involving the prescriber.
*Please keep in mind we can only assist with prior authorizations for prescriptions filled at a Genoa, a QoL Healthcare Company pharmacy.