Master the System, Reduce Denials, and Protect Patient Care
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Prior authorization is one of the most frustrating parts of modern pharmacy practice — for the pharmacist submitting the request, the prescriber waiting on an answer, and the patient stuck in the middle. This guide is written from the reviewing side of that process, by a pharmacist who has spent years evaluating prior authorization requests inside managed care.
It's built to help pharmacists and pharmacy teams understand what actually happens behind a determination, what makes a request more likely to succeed the first time, and how to work the system efficiently instead of fighting it case by case.
I'm building an AI-assisted PA adjudication platform where the engine surfaces recommendations, but a licensed pharmacist makes every final coverage decision — not the other way around.
See what I'm building →You're a practicing pharmacist handling prior authorizations and want practical, experience-based strategies for reducing avoidable denials and protecting patient care.
You're new to pharmacy and want foundational PA/UM concepts first — see the Pharmacist's Guide to Prior Authorization & Utilization Management for that starting point.
Digital PDF, instant download.
It's written from direct experience reviewing prior authorization requests, not generic theory.
It covers strategy and framework that applies across payers, since specific policies vary and change; always confirm current requirements with the specific plan.
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Frequently read together: this book focuses on day-to-day denial-reduction strategy, the other covers the broader PA/UM framework and career path.
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