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Here’s what you need to know about the drug prior authorization process


Your health-care provider may prescribe you a medication that will need prior authorization. 
 
Drug prior authorization is an approval process to ensure that certain medications being prescribed are covered under your benefits plan. 
 
You can use the online tool, My drug plan, to look up a drug and find out whether it is covered under your benefits plan or if prior authorization is needed. You can also see the approximate out-of-pocket expense to purchase the drug, as well as any alternatives (such as a generic version of the drug). 
 
Here are four (4) simple steps to guide you through the drug prior authorization process: 

Step 1: Look up a drug in My drug plan

To look up a drug in My drug plan:

  1. Go to www.otip.com and click Log in.
  2. Select Health and Dental from the drop-down menu and log in.
  3. After you have logged in, click My Claims.
  4. Select My drug plan under the My benefits list.
  5. Enter the information for your search.

 

Step 2: Complete
your Drug Prior
Authorization form

If your doctor prescribes a drug that needs drug prior authorization, you will need to complete the Drug Prior Authorization form. We recommend you complete your form with your doctor.

Step 3: Submit
your form

Submit your Drug Prior Authorization form per the instructions on the form.

Step 4: Decision outcome

You will receive notification once the form has been processed.

  • If your prescribed medication(s) is approved, it will be covered under your benefits plan.
  • If you receive a conditional approval, your prescribed medication(s) may be approved with a change in dosage or alternate medications may be recommended  
  • If the drug is not approved, you will receive notice of the decision.

 

Questions? We’re here to help. Contact Benefits Services at 1-866-783-6847 or send us an online note.

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