Primary care providers (PCPs) are similar to coaches, directing and coordinating all aspects of your health care - physical, emotional, and mental. They listen to your questions, assess symptoms, recommend treatment approaches, prescribe medication, and refer you to the proper specialist when needed.

Having a primary care provider is important since they direct and coordinate all aspects of your health care. Your PCP gets to know your health history as well as your family health history. Its important that you have a PCP whom you can build a long-term relationship with since that can translate to major health benefits over your lifetime, such as lower overall health costs, a decrease in hospital, urgent care, and/or ER visits, and better management of chronic diseases.

Primary care providers can identify health issues in their early stages before they become major problems. PCPs also offer other preventive care services such as annual wellness exams, immunizations, regular imaging, lab testing, cancer screenings as well as diet and lifestyle advice to maintain or improve your health.

Family medicine providers care for both children and adults while an internal medicine provider cares for those 18 and older (i.e., adults).

Nurse practitioners (NPs) are advanced practice registered nurses who have advanced clinical training. They can diagnose and treat medical conditions, perform advanced procedures, order lab testing and regular imaging, and prescribe medications.

In order to keep yourself in good overall health, you should see your PCP at least once a year for a physical exam to manage your health. For many health insurance plans, an annual physical exam is considered to be preventive care and, depending on your insurance plan, the annual physical exam is fully covered by your insurance.

Prior authorization (PA) is an approval of coverage from your insurance company, not your doctor. It’s a restriction put in place to determine whether or not they will pay for certain procedures, specialists, or medications.

Regarding medication, PAs are only required for prescriptions that are billed and paid through insurance. However, if you are uninsured or prefer to pay cash for your prescriptions, you do not have to worry about prior authorizations and can pay out-of-pocket for your medications.

Insurances will most likely require PAs for the following drugs:

• Brand-name drugs that have a generic available

• Drugs that are intended for certain age groups or conditions only

• Drugs used only for cosmetic reasons

• Drugs that are neither preventive nor used to treat non-life-threatening conditions

• Drugs (including those dosed at higher than standard doses) that may have adverse health effects, possibly dangerous interactions, and/or risks for abuse or misuse

• Drugs that are not covered by your insurance, but deemed medically necessary by your healthcare provider

If your prescription requires a prior authorization, the pharmacy will notify us and we will provide the necessary information to your insurance company. Based on the information given, your insurance company will decide whether or not to cover your medicine. You should hear back from your pharmacist about the insurance decision in about two to seven days. If you are approved, a PA only lasts for a set period of time and you will likely have to re-apply again in the future.

If your insurance denied your PA, you may have to pay the full out-of-pocket price of your prescription, or your insurance may require you to try an alternative covered medication as part of step therapy. However, if you believe your PA was incorrectly denied, you may submit an appeal to your insurance.