Prior authorization is used in many organizations’ extended health and dental benefit plans for high-cost medical services, supplies, and procedures. This includes prescription drugs.
For specific health conditions and/or prescription medications exceeding $5,000 per calendar year, per individual, prior approval (“Prior Authorization”) is required for reimbursement from the extended health plan. You and your healthcare provider must seek prior authorization for treatments related to the following conditions:
- Asthma
- Cancer
- Crohn’s Disease/Ulcerative Colitis
- Hepatitis C
- Hypercholesterolemia
- Multiple Sclerosis
- Psoriasis
- Psoriatic Arthritis
- Rheumatoid Arthritis
Starting from August 1, 2023, we’ve expanded the prior authorization program to include chronic weight management treatments. This update ensures that prescription drugs for chronic weight management, such as semaglutides, also prescribed for Type 2 Diabetes, are adjudicated appropriately. We have updated the information on our Prior Authorization page, to include information on chronic weight management.
How to apply for prior authorization
Details of the process for seeking prior authorization for these and other prescription drugs are detailed on the Prior Authorization page on the UBC HR website. You will find all the information you need to apply for prior authorization for these prescription drugs, including the steps to determine if you meet the established clinical criteria, FAQs, and the necessary forms.
If you have any questions or feedback, please Contact the Benefits team.
Posted in Articles
Tagged
- HR
- Benefits FYI