What category of drugs often requires prior authorization from insurance?

Specialty medications or high-cost medications often require prior authorization from insurance companies due to their unique characteristics, potential side effects, and costs. These medications are typically used to treat complex or chronic health conditions, such as certain cancers, multiple sclerosis, or rheumatoid arthritis. The expensive nature of these medications prompts insurance providers to ensure that patients meet specific criteria before approving coverage. This process helps manage healthcare costs and ensures that these treatments are necessary and appropriate for the patient’s condition.

Conversely, over-the-counter medications, generic medications, and non-prescription supplements generally do not require prior authorization because they can be purchased directly by consumers without a prescription. These types of products typically do not have the same level of scrutiny in the insurance approval process since they are deemed more accessible and easier to obtain.