Members new to Unity may be taking medications that require Prior Authorization for coverage. New members may also be in the process of selecting and making appointments with new Primary Care Physicians.
If, in checking Unity’s formulary, you find your medication requires prior authorization (PA), your first and best option is to have a conversation with the prescriber of that medication about alternatives that do not require PA or about having that prescriber submit a PA request on your behalf. If you cannot get in touch with the prescriber, or are changing physicians and have not yet been able to meet your new physician, you can call for a New Member Override to provide coverage during this transition.
To assist new members in making this transition, Unity provides coverage for their current medications that usually require Prior Authorization (PA) for up to 90 days (in 30 day increments at the usual copayment). After those 90 days, PA will be required before a member can receive additional coverage. Please note: this policy only applies to medications that a member was taking prior to joining Unity. Standard copays based on the member’s drug benefit and formulary status of the medication apply.
To request a “New Member Override,” you or your pharmacy may contact Unity Pharmacy Services at 800-788-2949 within the first 90 days of becoming a Unity member.
