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Prior authorizations: we initiate, your office completes, we follow through

When a claim comes back needing prior authorization, we start the electronic request where the plan allows a pharmacy to, and send it to your office to complete and submit. Everything around that request is ours to handle.

What OnPoint does

Flags the requirement when the claim rejects, instead of days later when the patient calls
Initiates the electronic prior authorization request, where the plan accepts pharmacy-initiated requests, and routes it to your office
Tells your office exactly what the plan is asking for: prior trials, chart notes, diagnosis, quantity
Tracks the request with the plan and follows up until there is a decision
Keeps the patient informed about status, cost and timing, so they are not calling your front desk
If the plan denies it, tells you the stated reason and what an appeal or a covered alternative would need

What only your office can do

Answer the clinical questions and attest to them
Submit the completed request to the plan
Start the request yourselves where the plan requires the prescriber to, such as NYRx
Decide, with the patient, whether to appeal or change therapy

NYRx (New York Medicaid)

NYRx requires the prescriber, or an authorized agent who works for the prescriber, to start prior authorization requests. For NYRx patients we tell your office precisely what is needed and follow up. If a patient cannot wait and you cannot be reached, the pharmacist can dispense up to a three-day emergency supply under NYRx's emergency process.

NYRx prior authorization FAQ · NYRx pharmacy policy guidelines

What we do not promise

The plan makes the coverage decision. We do not promise an approval, a turnaround time or a particular copay, and an approval on its own does not guarantee stock or payment. What we do promise is that the request will not sit unworked.

Send one script. That is the whole evaluation.

With the patient’s choice of pharmacy confirmed, send a prescription to OnPoint. We help coordinate coverage questions and refill follow-up with your office.

How to send a script Get the patient handout

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