The member’s physician is responsible for sending documentation to the Manatee YourChoice Pharmacy Technician via fax to provide information required to complete the authorization. This process is intended to ensure the safe and appropriate use of the desired medication. Please note: Optum Rx does not process prior authorizations.
Prior Authorizations may take up to 72 hours or longer, depending on response time from the prescribing physician. Call your Pharmacy Technician (see below) for more information on any necessary Prior Authorizations, Step Therapy, and Plan Limitations, or for more information regarding early refill due to vacation or business travel.
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Formulary status, including if a prior authorization will be required, is available on the Drug Lookup Tool.
Certain medications are subject to restrictions on their use. The most common restrictions are quantity limitations, age limitations, prior use of preferred medications, step therapy, prior authorizations, and gender. When the pharmacy processes a prescription, the PBM’s system will evaluate the member’s medication profile and determine whether any limitations apply. It will send a message back to the dispensing pharmacist with information regarding any limitations that have been applied to the prescription. Some limitations may require a Prior Authorization from the prescribing provider before the medication can be covered. The dispensing pharmacist should supply this information to you.
