A given insurer may require that a patient’s medical information or treatment history be provided to determine if VESIcare is covered. This process is referred to as prior authorization. Typically, patients will learn about this requirement when the pharmacist attempts to fill the prescription. However, in some cases, the physician may alert the patient to the requirement based on experience with other patients.

Often, prior authorization simply requires the physician to make a telephone call to the insurer to answer some questions about the patient’s past treatment history or medical condition. Other times, the information may need to be submitted using a particular form. Prior authorization processes often are designed to confirm a patient has tried other therapies before gaining access to a particular therapy. Providers can request an exception to such step therapy rules. For example, if patients have a medical history or condition that suggest other therapies should not be tried or have failed before moving onto VESIcare, providers can provide that information as part of the prior authorization request. Similarly, if a therapy such as VESIcare is subject to a greater copayment than the therapies the insurer typically would like tried first, the provider may also be able to request an exception.

Please note: reimbursement specialists at Astellas Reimbursement Services (ARS) may not submit prior authorization requests on behalf of a medical provider.

VESIcare may be subject to prior authorization by some plans, such as UnitedHealthcare Medicare Part D Plans, Community Care RX and WellCare. Addiditional information can be found at www.AARPMedicareRx.com, www.universalamerican.com and www.wellcarepdp.com.

Please see Forms and Documents section for form.