Prescription drug prior authorizations
Prior authorization brings your health plan and provider together to support safe, effective treatment options.
It helps you avoid unexpected bills by making sure a service or medication is covered before you receive it.
- You may need medical prior authorization for certain services, such as outpatient procedures, imaging, specialized care, or non-emergency hospital admissions.
- You may need prescription drug prior authorization for certain medications covered under your plan’s prescription drug benefit.
Check before you request
Review the list of covered prescription drugs, called a drug formulary, for your plan.
Use Blue Shield’s Price Check My Rx tool to view medication costs, coverage information, and possible alternatives so you understand your options before submitting a request.
How it works
1. In most cases, your provider submits the prior authorization request for you. They send information about the services or medication to Blue Shield.
2. Our clinical team checks that the request meets medical and plan requirements. If your situation is urgent, we will review more quickly.
- For prescription drugs from a pharmacy, the team makes a decision in 72 hours or 24 hours, if urgent.
- For prescription drugs you receive in a medical office or facility, the team typically makes a decision within 5 business days.
3. Once our clinical team makes a decision, Blue Shield notifies both you and your provider.
4. If approved, you can move forward with your medical services or fill your prescription. You’ll receive coverage consistent with your plan benefits. If your treatment isn’t approved, we’ll include an explanation.
Request a coverage decision, prior authorization, or exception for your Medicare prescription drug coverage.
Access forms, templates, and referral resources for Medicare, Medi-Cal, and prescription drug requests.
Your doctor typically handles this, but you can request a prior authorization on your own if needed.
- Log in to view your prior authorizations
- Call the number on your member ID card
- Contact your provider for an update
Y0118_25_514A4_C 08102026
H2819_25_514A4_C 08102026
Page last updated: 8/25/2026