Some drugs must be approved by Unity before they are covered. To see which drugs need Prior Authorization, check Unity’s formulary or see the medication prior authorization list.
Please note: Some medications given by a doctor or nurse in a clinic setting require an approved prior authorization before they are covered under your medical benefit. Review the medication prior authorization list to learn more.
For prior authorization, a request may be started by members, providers or designated representatives via the web, fax, mail, or telephone. Unity strongly recommends that you ask your health care practitioner to initiate the prior authorization request process on your behalf. This is because your healthcare practitioner will be able to include the medical history necessary for us to make a timely decision based on all of the relevant information.
For a prior authorization request the Medication Prior Authorization Request Form should be completed by the prescriber and submitted via SECURE electronic submission or via fax. We will accept prior authorization request forms from members or their authorized representatives but recommend having your health care practitioner complete the forms as discussed above. Unity makes decisions on standard prior authorization requests in a timely manner, but if additional information is necessary it may take as long as 15 calendar days.
If the request is considered URGENT, the request form should be completed and faxed directly to the number on the form. The request must provide clinical documentation FROM THE PRESCRIBER and the PRESCRIBER’s SIGNATURE describing why the request is urgent. Requests will only be treated as urgent for clinical reasons. Without documentation to support the urgency of the request, it may be treated as a standard request.
Prior Authorization Requests are reviewed by pharmacists using criteria set by Unity’s Pharmacy and Therapeutic (P&T) Committee. In most cases, decisions are made and notifications are sent within two business days after Unity receives the request.
If more information is needed, Unity 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.
If your Prior Authorization Request is approved, your copay will match the formulary and brand / generic status of the drug.
If your Prior Authorization Request is denied, you will have no coverage for the drug from Unity.
- The denial letter will include the reasons for the denial
- If you want to talk to someone about the denial, call the UW Health Pharmacy Benefit Management Program at 888.450.4884
- 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 Unity
Note: Prior Authorization only affects whether or not a medication is covered by Unity.
Contact Unity Customer Service by sending a message.