Effective October 1, 2018, WSI requires an annual renewal of authorization for a brand name medication in lieu of a generic equivalent. If a provider submitted a request for a brand name medication before October 1, 2018, a new request will be required prior to reaching the one-year timeframe. For example, if a provider submitted a request on March 1, 2018, another request would be required before March 1, 2019.
A provider may request prior authorization of a brand name medication in lieu of the generic equivalent by completing the Provider's Request for Medication Prior Authorization (M11). The Prior Authorization for Brand Necessary Medications medical policy outlines the circumstances under which WSI approves an authorization request for brand name medication.
If you have questions about this article, please send an email to wsipr@nd.gov. To receive provider news, subscribe to our Email Updates list.