Horizon Brief Notes on Indefinite Authorization Reviews for Horizon Pharmacy Members
Posted on November 10, 2023
See below Horizon Brief Notes on Indefinite Authorization Reviews for Horizon Pharmacy Members
Applies to: Commercial fully insured and self-insured groups
To help your customers’ covered employees achieve their best health, lower costs and ensure appropriate utilization and review of medications, we will be ending all indefinite authorizations on December 31, 2023. After review of these authorizations, we have determined that some medications may still need an authorization (subject to formulary exception or utilization management review) to continue being filled, and some may not require any authorization.
Why We Are Ending Indefinite Authorizations
Generally, the maximum duration for drug authorizations is 12 months to ensure annual review for safe and appropriate drug utilization. There are several different reasons why such indefinite authorizations may have been in a member’s profile. Because there is such variability with the history behind these authorizations, not all authorizations underwent a full clinical review for safe and appropriate utilization.
How This Impacts Members and Their Doctors
If members need the medicine(s), they can fill the prescription(s) until the authorization(s) is no longer active (until December 31, 2023).
After December 31, 2023, the medicine may need a new prior authorization or a formulary exception for the medicine(s) to be covered.
If they do not need the medicine(s) OR the medicine does not need any authorization to continue filling, there is nothing the member or doctor needs to do.
If a member has questions about their Horizon Pharmacy plan, they can call Pharmacy Member Services at 1-800-370-5088, 24/7.