Plan sponsors design their Part D benefits and plan features to appeal to prospective beneficiaries and ensure efficient, appropriate access to covered benefits. Prior authorizations (PA) are one of the many important and widely used features of Medicare Part D plans. With a focus on prescription drugs, this report highlights the primary purposes of PA and identifies key CMS regulations. It assesses the benefits and some challenges with the PA process and identifies potential opportunities for improvement.

This report was commissioned by the Blue Cross Blue Shield Association.