Certified Pharmacy Technician

• Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required

• Obtain verbal authorizations and request detailed clinical information from prescribers

• Approve coverage determination requests based on defined criteria

• Enter and document coverage determination request decision into the PBM system and notify providers and/or members

• Respond to client inquiries regarding authorization approvals and PBM on-line applications

• Refer coverage determination requests for specialty drugs to delegated vendor or client for processing

• Contact providers for additional information to facilitate coverage determination reviews

• Notify physicians, providers and members of coverage determination request decisions