Unity Pharmacy

Medication Prior Authorization

 

Requesting Prior Authorization for Medications

  • The following clinical information is needed for each request:
    • Name of drug (and J code or CPT code, if applicable) for which coverage is requested
    • Diagnosis
    • Names of ​preferred medications that have been tried and trial dates
    • Problems with ​preferred medications, such as lack of effectiveness or adverse effects
    • Rationale for using the ​non-preferred or restricted medication
  • A clinical pharmacist will review the request using Unity’s prior authorization criteria to determine coverage
  • Requestors and patients will be notified of the decision by fax and mail, respectively
  • Prior authorization approval notifications will be sent to the patient’s pharmacy if the pharmacy name is included on the request
  • Practitioners and patients may appeal a determination by calling Unity Customer Service at 800.362.3310 and notifying the representative that you wish to appeal
  • Unity makes decisions on most standard prior authorization requests within 2 business days, but if additional information is necessary it may take as long as 15 calendar days


If a request is Urgent, there is a 5 day emergency supply option available as well as a new member drug supply option available.


If you have questions about Unity’s prior authorization criteria or a specific determination, contact the Quartz Pharmacy Program at 888.450.4884.