After a final determination has been made for a prior authorization request (PAR), pharmacy benefit managers (PBMs) will receive an email notification. The email notification will be sent to the Medication Final Determination email entered by the payer's Medical Portal Online Administrator. The following PAR information will be contained in the email:
- PAR ID number
- Last four digits of patient’s Social Security number
- Claim administrator claim number
- Provider name
- Provider NPI
The emails will also contain details of the prescription, including:
- Medication request/strength
- Quantity requested
- Days supply
- Number of refills
- Status of PAR
- Rationale
The email below is an example of a request that was denied at a Level 3 review (Board’s Medical Director’s Office).
The email below is an example of a request that was granted at the payer’s Level 1 review.
