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.


Nurse Advice Line
Doctors in an emergency room with patient,What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, you can call our Nurse Advice Line for help. They can help you decide if you should see a primary or urgent care doctor. The Nurse Advice Line is free and available 24/7 for members at 1-866-418-2920 (TTY Relay: 7-1-1).



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