Which of the following is an example of a prior approval type?

• A. Request for restricted meds
• B. Set of guidelines for patient education
• C. Prescription fill without PA
• D. Generic substitution

Answer: (A)

Prior authorization is a process where the insurer must approve coverage for a medication before it is dispensed, usually for drugs that are restricted or require justification of medical necessity. A request for restricted meds is an example of this process because it directly involves submitting information to obtain payer approval for a drug that is not automatically covered. The other options don’t involve getting payer approval: guidelines for patient education are educational resources, not a payment approval step; a prescription filled without prior authorization means no PA was needed or obtained; and generic substitution concerns substituting a generic version for a brand name under formulary rules, which is a substitution policy rather than a PA action.