There isn’t a specific form your healthcare professional needs to fill out to request prior authorization. They can submit their request directly to Medicare by fax or mail, through the ...

Step therapy is a specific form of prior authorization in which the ... determine what reasons to cite. If Medicare approves a person’s request, their plan will cover the requested drug without ...

The practice differs by insurance company and plan, but the rules often require patients or their doctors to request ...

Medicare Advantage insurers had urged CMS to scrap the obesity drug coverage proposals and eliminate a health equity payment ...

CMS has published its final rule for Medicare Advantage and Part D in 2026, outlining a series of regulatory updates aimed at ...

In 2023, Medicare Advantage insurers made nearly 50 million prior authorization determinations. As enrollments in MA plans have grown, the number of prior authorizations has steadily increased ...

Last year, only 26% of the provider groups UnitedHealthcare works with submitted more than one prior authorization request, Docimo said. "It may be perceived as prevalent, but it's not required in ...

Prior authorization typically takes about 10 days for Original Medicare and Part C. However, starting in 2025, CMS has reduced this to 7 days. Doctors can also request an expedited review ...