A patient with a new prescription is at the medical office. The prescription is for a non-formulary medication that requires prior authorization. What is the most appropriate next step for the medical assistant to ensure the medication is covered and dispensed to the patient?
Initiate the prior authorization process with the insurance company for the prescribed medication.
Inform the patient that the medication is non-formulary and advise them to pay the full cost out-of-pocket.
Contact the healthcare provider to immediately change the prescription to a formulary medication.
Schedule a follow-up appointment for the patient to discuss alternative treatments.
The most appropriate next step is to initiate the prior authorization process for the medication. This involves communicating with the patient’s insurance company to get approval for coverage of a non-formulary medication. Not initiating this process would likely result in the patient's prescription not being covered by insurance, while contacting the provider to change the medication or advising the patient to pay out-of-pocket are less appropriate next steps before attempting to secure coverage for the prescribed medication.
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