Some drugs must be approved by Physicians Plus before they are covered. This process is called Prior Authorization.

To see which drugs need Medication Prior Authorization, check your formulary or see the list of prior authorization forms by drug name.

You can also see the Medication Prior Authorization List.

Does your doctor or nurse give you your medicine (through an IV, for example)?

If so, you may need an approved Prior Authorization first. Be sure to check the Medication Prior Authorization List. If the medicine is on that list, you need to get a Medication Prior Authorization.

Your clinic staff can help you.

How do I get a Medication Prior Authorization (PA)?

You or your doctor can fill out a Medication Prior Authorization Request (PA Request). Or your designated representative can fill it out. You can send it in via the web, fax, mail, or telephone.

It makes the most sense to have your doctor / nurse or pharmacist fill out the PA Request for you. They will have your medical history information that is needed. That means the PA Request can be reviewed more quickly.

Once the Medication PA Request Form is filled out, it has to be sent to Physicians Plus in a secure way.

Secure Online Medication PA Request Form

Download and Print Medication PA Request Form
(Fax using a secure fax number).

Once Physicians Plus gets the Medication PA Form, we make a decision as soon as possible. However, if we don’t have all the information and have to ask questions, it can take up to 15 days.

Once a decision is made, we will send a notice to you and your doctor.

If the request is URGENT, the request must:

  • Provide clinical documentation from the prescriber (doctor).
  • Describe why the request is urgent.
  • Have the prescribers' signature.

Requests will only be treated as urgent for documented clinical reasons. Otherwise the request will be processed normally.


Reviewing Requests

Prior Authorization requests are reviewed by pharmacists using criteria set by the Quartz Pharmacy and Therapeutic (P&T) Committee. In most cases, decisions are made and notifications are sent within five business days after Physicians Plus receives the request.

If more information is needed, Physicians Plus will contact your practitioner. In that case, the decision and notice may take as long as 15 days. This depends on how quickly your practitioner provides the needed details.

Approved Requests

If your Prior Authorization Request is approved, your copay will match the formulary and brand / generic status of the drug.

Denied Requests

If your Prior Authorization request is denied, you will have no coverage for the drug from Physicians Plus.

  • The denial letter will include the reasons for the denial
  • If you want to talk to someone about the denial, call Physicians Plus Pharmacy Services at (800) 545-5015 or (608) 260-7803.
  • You can still buy the prescription drug , but you will have to pay the full cost
  • You can talk to your practitioner about getting a similar drug that is covered by Physicians Plus

Note: Prior Authorization only affects whether or not a medication is covered by Physicians Plus.

Questions?

Contact Physicians Plus Customer Service by sending a message.


This health plan is underwritten by Physicians Plus Insurance, Inc.