What is Prior Authorization?
Some medical services, surgical procedures, and medications require IHN-CCO’s written approval before you can get them. This process is called prior authorization, also called prior approval. It basically means that your provider has to ask permission to prescribe you a drug or have you undergo a treatment, service, or surgery that isn’t covered by your health plan.
How does it work?
Your provider fills out a form requesting permission to give you a certain drug, treatment, service, or surgery. If approved, it will be covered to some extent by IHN-CCO. If not, IHN-CCO may recommend an alternative that is covered, or you may opt to get the drug, treatment, service, or surgery anyway and cover the costs yourself.
What requires authorization?
IHN-CCO reviews and updates its Prior Approval List annually. For 2019, IHN-CCO requires prior authorization for the following: