What type of medication often requires prior authorization?

Prior authorization is a cost-control mechanism that insurance companies use to manage the use of certain medications. Expensive brand name drugs often require prior authorization because they typically come with a higher cost burden, and insurance providers want to ensure that these expensive options are used only when necessary. This process allows insurers to assess whether the drug is medically appropriate for the patient, whether it is a preferred alternative available at a lower cost, or if it aligns with established treatment protocols.

In contrast, generic drugs usually do not require prior authorization, as they are generally less expensive and considered interchangeable with their brand-name counterparts. Over-the-counter medications are available without a prescription and do not require prior authorization since they are not covered by insurance in most cases. Prescription supplements, while they may vary based on the insurance plan, do not typically fall under the same scrutiny as high-cost medications, thus may not require prior authorization either.

The focus on prior authorization for expensive brand name drugs helps insurers control costs while ensuring that patients receive appropriate care based on clinical necessity.