Why do health plans require prior authorization? - Community Health Plan of Washington - Medicare Advantage

Why do health plans require prior authorization?

The prior authorization process gives the health plan a chance to review how necessary certain services or medications may be in treating your medical condition. For example, some brand name medications are very costly. During the review, the health plan may decide a generic or another lower cost alternative may work equally well in treating your medical condition.

Prior authorization restricts access to costly services and therapies – particularly new treatments. It is also used to determine medical necessity and appropriateness of care.

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