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Specialty Medication Prior Authorizations

In 2023, National CooperativeRx took over specialty medication prior authorizations for our member groups’ plan participants. Similar to our innovative clinical programs, this service is provided at no cost to our members.

Controlling Specialty Costs

We identified an opportunity to save members millions of dollars in specialty medication costs – by managing specialty medication prior authorization functions within our Cooperative.

Since taking over specialty medication prior authorization functions, we have been able to demonstrate significant savings, an elevated level of clinical quality, and enhanced customer service. Based on historical trends and market comparisons, we estimate that National CooperativeRx’s specialty medication prior authorization program contributed to approximately $25 million in cost avoidance across our Cooperative in 2024. 

Read our blog to learn more about the success of our specialty medication prior authorization program.

Business person reviewing prior authorizations

Specialty medications are prescriptions used to treat specific chronic and/or genetic conditions. Specialty medications are costly to pharmacy benefit plans due to their higher costs to develop, lower rate of use, and special handling for transporting and dispensing.

a group of people reviewing information on laptop

A prior authorization is the review of a medication or procedure to ensure clinical appropriateness. Ensuring that a member meets prior authorization criteria before coverage of a medication or procedure helps ensure safe, appropriate care and efficient use of health care dollars.

More Information

Contact Specialty Prior Authorization Department

1-877-205-6592 toll-free

1-866-278-8190

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