Using Your Pharmacy Benefits


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Medication Prior Authorization

Some medications on Unity’s Prescription Drug Formulary require an approved Prior Authorization prior to coverage through Unity. To see which medications need Prior Authorization, refer to Unity’s formulary. To request Prior Authorization, the Prior Authorization / Formulary Exception Request Form must be submitted to Unity via fax or mail. It is best that your practitioner submit this form, as clinical information is required for processing. If your practitioner thinks your need for the medication is urgent, he or she should write “urgent” on the fax. Urgent requests are reviewed first.

Reviewing Requests
Requests are reviewed by pharmacists based on criteria set by the Pharmacy and Theraputic (P&T) Committee.  You and your practitioner will receive written notification of the decision. Generally, decisions are made, and notifications sent within two business days of receipt of the request by Unity. If Unity needs more information, it will be requested of your practitioner and the decision and notification may take as long as 15 days depending on how quickly the information is received.

Approved Requests
If your Prior Authorization Request is approved, your copay will match the formulary and brand/generic status of the drug.

Denied Requests
If your Prior Authorization Request is denied, you will have no coverage for the medication under your Unity Prescription Drug Benefit.

Note: Prior Authorization only affects whether or not a restricted medication is covered under your Unity Prescription Drug Benefit. You will still need to pay the copay corresponding to the tier of the drug.