Prescription Pre-Authorization
Getting medications approved
Handling the paperwork and advocacy to ensure insurance approves needed medications
Why does prescription pre-authorization matter?
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Insurance companies require prior authorization for many medications—proof that the drug is medically necessary before they'll cover it. This process delays treatment and often results in denials that could have been avoided with proper documentation. Weltrio handles the process.
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See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Authorization Management
We handle the prior authorization process—identifying requirements, gathering documentation, and submitting to insurance for approval.
Documentation Support
Prior authorizations require clinical documentation supporting medical necessity. We help compile and format documentation that maximizes approval likelihood.
Status Tracking
Once submitted, we track authorization status and follow up to ensure timely decisions. No more wondering if your request got lost.
Appeal Support
When authorizations are denied, we support appeals. Many denials are overturned with proper appeals—we know how to construct them.
What is Prescription Pre-Authorization?
Prescription Pre-Authorization is the insurance approval process required before coverage applies to certain medications.
Insurers use prior authorization to control costs—ensuring expensive medications are used appropriately. In theory, this protects against waste. In practice, it often delays needed treatment and requires significant administrative effort.
Weltrio handles this process on employees' behalf—determining requirements, gathering documentation, submitting requests, tracking status, and appealing denials when they occur.
Why Do Prior Authorizations Fail?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Prior authorization support handles medication approvals from start to finish.
Requirement Identification
When a medication requires prior authorization, we identify specific requirements—what documentation is needed and what criteria must be met.
Documentation Gathering
We coordinate with prescribers to gather required clinical documentation that supports medical necessity for the medication.
Submission & Tracking
We submit the prior authorization request and actively track status, following up with insurers to ensure timely processing.
Resolution & Appeals
We communicate approval status. If denied, we assess appeal options and support the appeal process to overturn inappropriate denials.
When Is Prior Authorization Required?
Prior authorization requirements vary by insurance plan, but commonly apply to:
• Brand medications when generics exist
• Specialty and high-cost medications
• Medications with abuse potential
• Off-label uses of medications
• Quantities exceeding standard limits
• Step therapy overrides
We determine authorization requirements for any medication and help navigate the process.
Where Does Prior Authorization Apply?
Prior authorization applies regardless of where medications are obtained:
• Retail pharmacy prescriptions
• Mail-order medication orders
• Specialty pharmacy fills
• Provider-administered medications
The authorization requirement comes from insurance, not the pharmacy source.
Who Benefits from Prior Authorization Support?
Any employee facing medication authorization requirements:
• Those prescribed medications requiring approval
• Employees whose authorizations have been denied
• Anyone confused about the authorization process
• People starting expensive or specialty medications
• Those who've experienced prior authorization delays
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
