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Prior Authorization for Medication

Federal & State Law Editorial TeamLast reviewed: April 2026

Request for insurance approval before prescribing a medication that requires prior authorization under the patient's health plan.

PDF TemplateUse the instructions below to complete this form

Instructions

Include the patient's insurance information, diagnosis codes (ICD-10), the medication name, dose, and duration. Provide clinical justification explaining why the requested medication is medically necessary and why formulary alternatives are inadequate. Attach supporting documentation such as lab results or clinical notes. Insurers must respond within 72 hours for non-urgent requests and 24 hours for urgent requests.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.