What is the process for obtaining prior authorization for a medication?

The process for obtaining prior authorization for a medication typically begins with the prescribing physician. The physician must first determine whether the medication that he or she intends to prescribe requires prior authorization under the patient's specific CIGNA insurance plan. This information can usually be found in the plan's formulary or medication guidelines. Once the physician confirms the need for prior authorization, he or she must submit a request to CIGNA. This request usually includes detailed information such as the patient's medical history, the rationale for prescribing the medication, and any relevant laboratory results or documentation that supports the necessity of the medication. The physician may utilize CIGNA's online tools or contact CIGNA directly for assistance during the process. After CIGNA receives the prior authorization request, it is reviewed by a clinical team who will evaluate the information provided against the plan’s specific criteria for coverage. This review typically takes a few business days, although the timing may vary based on the complexity of the case and the information submitted. Once a decision is made, CIGNA will notify the physician and may also inform the patient about the outcome. If the request is denied, the physician can appeal the decision or discuss alternative treatment options with the patient. For further details about prior authorization or to check specific requirements, one can visit the current CIGNA website, which offers resources and contact information.