Prior Authorization
MassMedLine receives requests each day from physicians’ offices seeking prior authorization information. The majority of these requests are for patients who have both Medicare and MassHealth. Since January 2006 all MassHealth individuals who are eligible for Medicare are required to have a Medicare Prescription Drug plan. This plan is their main source for prescription coverage, however there are some exceptions such as Benzodiazepines, Barbiturates, some over the counter medications and Part B medications. Each of the 50 stand alone Medicare Prescription Drug plans has their own formulary and their own process for prior authorizations. We have compiled the phone numbers for each plan to start a prior authorization. You can access this information here.
Many physician’s offices are not aware of the Medicare Prescription Drug plan their patient has. The best ways of finding out what plan a patient has are contacting the patient directly or contacting the pharmacy the patient goes to. Another way to access this information is by calling Medicare directly (1-800-633-4227) or going to the Medicare Website. Once on the Medicare website click on “Check Current Enrollment” on the right hand side and then click on “Check My Enrollment” on the bottom left. In order to access the patients plan information you must have five pieces of information including their Medicare Claim number and Medicare Part A or B effective date.
MassMedLine pharmacists can also assist in this process by reviewing a plan’s formulary to see what medications are covered by a Medicare Prescription Drug Plan, sometimes resulting in a simple switch to a similar medication rather than going through a prior authorization process. Please call MassMedLine directly for more information.