What does prior authorization typically refer to in pharmacy benefits?

Prior authorization is a process used in pharmacy benefits that necessitates obtaining approval from a health insurance company before a specific medication will be covered under a patient’s drug plan. This requirement is put in place to ensure that the medication being prescribed is medically necessary and meets certain criteria established by the insurance provider. By requiring prior authorization, insurers can help control costs and ensure patients receive appropriate therapy based on clinical guidelines.

The other options, while related to healthcare and pharmacy benefits, do not accurately define prior authorization. The method of expediting claims processing typically involves different procedures not tied to the approval of specific medications. Insurance premium payments refer to the cost paid by the insured for their health coverage, not the prior approval for drugs. Finally, consumer choice for lower drug prices relates more to selecting among various medication options or pharmacies rather than the authorization process required for insurance coverage of those drugs.