The DRx Experience

Member-First
Prior Authorizations. Real Clinical Support.

WATCH VIDEO ON PAs

Why Prior Authorizations
Matter.

Some prescriptions need a review before your plan covers them. That review is called a prior authorization. It's a required step that confirms the medication is safe, right for your condition, and the most cost-effective option available.

  • Prescription Safety
  • Right for You
  • Cost-Effective

A Real Person Handles Your PA.

Your PA runs through the DisclosedRx pharmacist team. A pharmacist reviews it, works with your prescriber, and oversees the process, communicating with you along the way.

What to Do
When Your Medication Requires a PA.

Got a PA notice? Don't panic. This is a standard process and we've developed a strategy to make it as easy as possible for you. Our goal is to ensure you get your medication with as little disruption as possible. Most of the work happens without you, but here's what you need to know:

Check the Member Portal.

Register or log in to the Member Portal, then look up your medication on the Formulary List under Member Resources to see whether prior authorization is required.

Open the formulary lookup tool

If a PA is Required.

Give your prescriber a heads-up. PAs are submitted by your prescriber's office, not by you. But a quick note can be helpful and lets them get a head start.

We take it from here.

Our pharmacist team reviews the request and notifies you, your prescriber, and your pharmacy of the decision, the reasons behind it, and what happens next.

Questions about your PA? Talk to a Member Advocate.

480-561-6005

If you already have a prior authorization when you move to DisclosedRx,
it comes with you.

Our clinical team reviews every active prior authorization from your previous plan. Approvals carry over, and you don't restart the process for a medication you're already approved to take.

Types of Medications We Review

Four kinds of medications get a closer look before receiving approval.

GLP-1 medications

Reviewed against your plan's clinical criteria to confirm coverage requirements are met.

Specialty medications

Some medications need to be prescribed or filled through certain prescribers or pharmacies. Our team coordinates the process.

Explainer video

Formulary medications

When a similar, lower-cost medication works in the same way and is expected to provide the same clinical benefit, the plan may require it to be tried first.

High-risk medications

Checked for appropriate dosing, potential interactions and safe use.

How long it takes

While timelines vary by your specific situation, most PAs move quickly.

Urgent

48 hours

Standard

7 days

FAQs

How do I know if my medication needs a prior authorization?
Your member portal's formulary lookup tool shows whether a PA applies.
What happens if I’m told a prior authorization is required at the pharmacy?
If you receive a rejection, a Member Advocate and our clinical team work with you, your doctor, and your pharmacist to resolve it.
Why Does My Prescription Require Additional Review?
Your prescriber plays the most important role in your care, and DisclosedRx supports those decisions while making sure your medications are safe, effective, and affordable. Sometimes a prescription needs an extra step before it's covered: we check for whether a lower-cost option would work just as well. If so, your plan may require you to try that first. If your prescriber believes the alternative is not appropriate, they can provide additional clinical information for our team to review.

Questions about your PA? Talk to a Member Advocate.

Contact Us

Or call us direct: 480-561-6005