Contact your doctor. They’ll initiate the prior authorization request with Express Scripts on your behalf, providing necessary medical information. This typically includes details about your medical history, current medications, and the reason Viagra is medically necessary for you.
Required Documentation
Express Scripts may require additional documentation to approve your prescription. This can vary, but commonly includes:
- Detailed information about erectile dysfunction diagnosis and treatment attempts. Results of relevant medical tests. Documentation ruling out contraindications for Viagra.
Your physician should provide all requested documentation. Incomplete submissions frequently delay approval.
Tracking Your Request
After your doctor submits the request, you can typically track its status online through Express Scripts’ member portal. Check regularly for updates. If the request is denied, you or your doctor can appeal the decision with additional documentation and explanations.
Common Reasons for Denial
Denials often stem from missing information or insufficient justification for Viagra’s medical necessity. Ensure your doctor provides comprehensive medical history and thoroughly explains the treatment rationale. Here are some potential issues:
Lack of adequate documentation of erectile dysfunction. Failure to demonstrate that other treatment options have been unsuccessful. Inconsistent or incomplete information provided in the request.
Next Steps After Denial
If your prior authorization is denied, your doctor should work with you and Express Scripts to appeal the decision. This often involves providing additional medical information or exploring alternative treatment options.
Contacting Express Scripts
For specific questions or concerns about the prior authorization process, contact Express Scripts directly using the phone number or online resources provided on your member card or their website. Remember to have your member ID ready.
Alternative Treatments
Your doctor may discuss alternative treatments for erectile dysfunction if Viagra is not approved. Open communication is key to finding the best approach for your individual health needs.
