medicaid

[beckya117]

my friend always having trouble getting her pain meds and other meds filled because they say she has to have a PA (prior authorization) and she has Medicaid does anyone kknow what this means and why

[Totie]

I have to have prior authorization (PA) from my doctor on the Ambien.
It means your doctor has you on it for a legit reason as far as medically needed.

My insurance sent me a form asking that I get my doctor to fill out and fax. My letter is good for up to a year. If I did not have that I would have to pay $90.00 for it, instead of the $4.00 with my prescription insurance.

[ILADVOCATE]

  That means that Medicaid wont coverage for them without a specific written request (there is a form for this as well) with a doctor's letter. There is a formulary meaning medications they generally cover
and other medications might only be specifically covered with this process.
However if the follow up is done correctly there should not be a problem.
   Call the Medicaid hotline for more information and also ask where the doctor should call to request necessary forms. This should work out
without a problem but if it doesn't there is an appeals process
where if it can be medically substantiated why medications
on their formulary didn't work or couldn't be tolerated, coverage
should be granted.
  Generally once Medicaid has this information on the record
from the doctor the process should be less difficult over time.