Who approves a prior authorization before dispensing a medication?

• A. The pharmacist
• B. The patient
• C. The insurer
• D. The prescriber

Answer: (C)

Prior authorization is a step where a payer determines whether a prescribed medication will be covered under the patient’s plan. The decision to approve or deny rests with the insurer, who reviews the request for medical necessity, formulary status, and any required criteria (like step therapy or quantity limits). The prescriber initiates the PA and provides clinical justification, and the pharmacist can help gather and submit documentation, but the actual approval comes from the insurer. If the insurer approves, dispensing proceeds with coverage; if not, alternatives or different coverage may be pursued.