Prior authorization is primarily required for which type of medication?

Prior authorization is primarily required for controlled substances due to regulatory concerns and the potential for misuse or abuse. Controlled substances often include medications that have a higher risk of dependency or are subject to strict regulations to prevent illicit use. The prior authorization process helps insurers manage costs and ensure that these medications are prescribed only when absolutely necessary, following established guidelines. It requires healthcare providers to provide justification for the use of these medications, enhancing patient safety and promoting responsible prescribing practices.

Over-the-counter medications typically do not require prior authorization because they can be purchased directly by patients without a prescription. Non-controlled substances may also require less oversight than controlled substances, as they generally have a lower potential for abuse. Thus, controlled substances are the primary focus of prior authorization requests.