Understanding Prescription Drug Prior Authorization
Prior authorization is designed to help protect patients and health care providers by ensuring the appropriate use of prescription medications.
The prescription drug benefit is the most commonly used component of employer group health plans. Given how much prescription drug coverage is valued by employees and their families, it's important that claims costs are managed so that the plan will be there when it's needed most.
What is prior authorization?
Prior authorization is designed to protect patients and health care providers by ensuring the appropriate use of prescription medications. Prior authorization is used to help plan providers ensure that their members are not being prescribed the most costly medication, until less expensive alternatives have been pursued. This "cost check" helps keep overall plan costs down and allows employers to continue offering drug benefits.
Prior authorization at RBC Insurance
Our prior authorization program helps manage rising drug claims costs, while providing plan members with access to appropriate drug therapy.
Which drugs require prior authorization?
High-cost drugs and some biologics, which are products derived from living sources as opposed to chemical compositions (also called specialty drugs) are included on RBC Insurance's prior authorization drug list. RBC Insurance does not publish its prior authorization drug list as the list can change frequently, with new drugs being added and others removed.
To find out if a drug you have been prescribed is on the prior authorization list, use our DIN look up online or our app or call the Health & Dental Claims Centre at 1-855-264-2174. If you're taking a drug on the RBC Insurance prior authorization drug list, take the prior authorization (special authorization) form to your physician to complete.
What happens if I was covered for a prior authorization drug under my previous plan?
If you were on a drug listed on RBC's prior authorization list on a previous plan your drug will continue to be covered if you provide appropriate proof of coverage showing that the prior authorization drug was covered within the last 6 months. You will not be required to submit a completed prior authorization form.
Simply call the Health & Dental Claims Centre at 1-855-264-2174 and they will confirm the information we need to process your claim (for example, a copy of an approval letter from your previous insurance company or a pharmacy receipt).
How do I know if the drug I have been prescribed is on the prior authorization list?
To find out if a drug you have been prescribed is on the prior authorization list, call the Health & Dental Claims Centre at 1-855-264-2174 or use our Drug Identification Number (DIN) Look Up tool online or our app.