PDP question: 2025 renewal--is annual prior authorization required for a drug that has been approved in 2024

[yorkriver1]

The client could save some money by switching from the lower cost PDP to the more expensive/lower deductible PDP in the same company, but is concerned about needing to do prior authorization. No one has asked me before if prior authorization carries over assuming the drug is still in the formulary, year on year or if prior auth has to be re-authorized each plan year.

 

[Fisher]

Call the company. I would plan on PA being needed again, though.

 

[somarco]

Assume nothing.

Formulary changes, smaller pharmacy footprints and prior authorization rules all changed for 2025. It's almost required reading to look through the SOB before suggesting a plan.

Just today I had two clients ask for a copy of the pharm network and I can't ever recall having that come up before.

 

[goillini52]

Assume nothing.

Formulary changes, smaller pharmacy footprints and prior authorization rules all changed for 2025. It's almost required reading to look through the SOB before suggesting a plan.

Just today I had two clients ask for a copy of the pharm network and I can't ever recall having that come up before.

UHC hasn't even published their 2025 Formularies yet. How can they get away with that?

 

[hockeyday]

The client could save some money by switching from the lower cost PDP to the more expensive/lower deductible PDP in the same company, but is concerned about needing to do prior authorization. No one has asked me before if prior authorization carries over assuming the drug is still in the formulary, year on year or if prior auth has to be re-authorized each plan year.

Will needto be redone