Everyone’s mental health treatment journey looks different. For some, talk therapy is enough. For others, medication is needed to help manage symptoms. If your provider recommends medication, it’s important to be prepared by knowing what your insurance will cover.
Prior authorization means your insurance needs to approve your prescribed medication before your pharmacy fills it. If your insurance doesn’t approve it, you’ll either need to pay out of pocket for the prescription or go back to your doctor for a different medication.
There is no exact amount of time prior authorization for medication will take. Oftentimes, it will be approved within just a few days, but it can take up to a few weeks for more specialized medication. If you need your medication sooner, you may want to file an urgent request, which may be approved in as little as 24 hours.
Typically, yes psychiatric medications are covered by insurance. However, cost and coverage varies by insurance plan. For information about your plan specifically, check your plan’s formulary, or drug list. This will list out all prescription drugs covered by your health insurance.
Most major pharmacies will accept telehealth prescriptions, and your provider can electronically send the prescription straight to the pharmacy of your choice. However, not all pharmacies will accept telehealth prescriptions for controlled substances, such as opioids and stimulants.
Psychologists, therapists and counselors typically cannot prescribe medication. If you or your therapist believes you need mental health medication, you’ll have to arrange an appointment with your primary care provider or a psychiatrist. Primary care providers often handle medications for diagnoses like anxiety and depression If you have more complicated or severe conditions, they may refer you to a psychiatric office. There, psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants can all diagnose, treat and prescribe medications for mental health conditions.
First, check your insurance plan to determine if a referral is required. If you do need one, you’ll have to meet with your primary care doctor. You’ll discuss your symptoms and concerns with them and ask them to provide you with a referral for a specialist.
Community mental health services are local care options that support individuals with mental health challenges outside of the hospital system. This can include things like therapy, crisis intervention, case management, residential services, and more. The goal is to provide a path forward without a hospital stay, which may be disruptive for some.