{"id":25197,"date":"2024-08-08T16:36:04","date_gmt":"2024-08-08T20:36:04","guid":{"rendered":"https:\/\/www.elderplan.org\/?page_id=25197&#038;preview_id=25197"},"modified":"2026-04-13T14:53:10","modified_gmt":"2026-04-13T18:53:10","slug":"prior-authorization","status":"publish","type":"page","link":"https:\/\/www.elderplan.org\/zh\/member-benefits\/elderplan-benefits\/prescription-drugs\/prior-authorization\/","title":{"rendered":"\u4e8b\u5148\u6388\u6b0a"},"content":{"rendered":"<section class=\"wpb-content-wrapper\">\n<div class=\"wp-block-columns padding-interior is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<h2 class=\"wp-block-heading\" id=\"h-\u4ec0\u9ebc\u662f\u4e8b\u5148\u6388\u6b0a\">\u4ec0\u9ebc\u662f\u4e8b\u5148\u6388\u6b0a\uff1f<\/h2>\n\n\n\n<p>\u4e8b\u5148\u6388\u6b0a (PA) \u662f\u6211\u5011\u7684<a href=\"\/zh\/member-benefits\/elderplan-benefits\/prescription-drugs\/utilization-management\/\">\u4f7f\u7528\u7ba1\u7406<\/a>(UM) \u8a08\u5283\u7684\u4e00\u90e8\u5206\uff0c\u662f\u6307 Elderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u627f\u4fdd\u67d0\u4e9b\u8655\u65b9\u85e5\u6240\u9700\u7684\u7a0b\u5e8f\u3002 \u5982\u679c\u60a8\u7684\u85e5\u7269\u9700\u8981 PA\uff0c\u60a8\u3001\u60a8\u7684\u4ee3\u7406\u4eba\u6216\u60a8\u7684\u91ab\u751f\u5fc5\u9808\u5728\u60a8\u914d\u85e5\u524d\u8acb\u6c42\u7372\u5f97 Elderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u7684\u6838\u51c6\u3002 \u5982\u679c\u6c92\u6709\u7372\u5f97\u6838\u51c6\uff0cElderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u53ef\u80fd\u4e0d\u627f\u4fdd\u8a72\u85e5\u7269\u3002<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-\u70ba\u4ec0\u9ebc\u9700\u8981\u4e8b\u5148\u6388\u6b0a\"><strong>\u70ba\u4ec0\u9ebc\u9700\u8981\u4e8b\u5148\u6388\u6b0a\uff1f<\/strong><\/h3>\n\n\n\n<p>PA \u53ef\u78ba\u4fdd\u60a8\u7684\u798f\u5229\u5f97\u5230\u6700\u4f73\u5229\u7528\uff0c\u4e26\u7372\u5f97\u6700\u5408\u9069\u7684\u6cbb\u7642\u3002 \u4f8b\u5982\uff0c\u5982\u679c\u60a8\u7684\u91ab\u751f\u958b\u4e86\u4e00\u7a2e\u65b0\u7684\u7cd6\u5c3f\u75c5\u85e5\u7269\uff0cElderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u53ef\u80fd\u9700\u8981\u5728\u60a8\u914d\u85e5\u524d\u6838\u51c6\u3002<\/p>\n\n\n\n<p>\u4f5c\u70ba\u4e8b\u5148\u6388\u6b0a\u7a0b\u5e8f\u7684\u4e00\u90e8\u5206\uff0c\u6211\u5011\u9075\u5b88\u984d\u5916\u7684\u8981\u6c42\uff0c\u5982\u5206\u6b65\u6cbb\u7642\u548c\u6578\u91cf\u9650\u5236\u3002 \u8acb\u6aa2\u8996\u00a0<a href=\"https:\/\/www.elderplan.org\/files\/2026_pa-criteria_updated_10-15-25_accessible\">Elderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u7684\u4e8b\u5148\u6388\u6b0a\u6838\u51c6\u6e05\u55ae<\/a>\uff0c\u77ad\u89e3\u60a8\u7684\u85e5\u7269\u662f\u5426\u9700\u8981\u6388\u6b0a\u3002 \u60a8\u9084\u53ef\u4ee5\u4f7f\u7528\u53ef\u641c\u5c0b\u7684\u8655\u65b9\u85e5\u4e00\u89bd\u8868\u4f86\u78ba\u5b9a\u662f\u5426\u9700\u8981 PA\u3002<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-\u5206\u6b65\u6cbb\u7642-st\"><strong>\u5206\u6b65\u6cbb\u7642 (ST)<\/strong><\/h2>\n\n\n\n<p><strong>\u4ec0\u9ebc\u662f\u5206\u6b65\u6cbb\u7642\uff1f<\/strong><\/p>\n\n\n\n<p>\u5206\u6b65\u6cbb\u7642\u662f PA \u8a08\u5283\u7684\u4e00\u90e8\u5206\u3002 \u5b83\u53ef\u78ba\u4fdd\u60a8\u7372\u5f97\u9069\u7576\u4e14\u8ca0\u64d4\u5f97\u8d77\u7684\u6cbb\u7642\u3002 Elderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u53ef\u80fd\u6703\u8981\u6c42\u60a8\u5148\u8a66\u7528\u67d0\u4e9b\u85e5\u7269\uff0c\u7136\u5f8c\u518d\u627f\u4fdd\u6cbb\u7642\u540c\u4e00\u75c5\u75c7\u7684\u53e6\u4e00\u7a2e\u85e5\u7269\u3002 \u4f8b\u5982\uff0c\u5982\u679c A \u548c B \u85e5\u7269\u5747\u53ef\u6cbb\u7642\u60a8\u7684\u75c5\u75c7\uff0cElderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u53ef\u80fd\u53ea\u5728\u5148\u8a66\u7528 A \u85e5\u7269\u4f46\u767c\u73fe\u7121\u6548\u7684\u60c5\u6cc1\u4e0b\u624d\u627f\u4fdd B \u85e5\u7269\u3002<\/p>\n\n\n\n<p><strong>\u70ba\u4ec0\u9ebc\u9700\u8981\u5206\u6b65\u6cbb\u7642\uff1f<\/strong><\/p>\n\n\n\n<p>\u5206\u6b65\u6cbb\u7642\u4fc3\u9032\u5b89\u5168\u548c\u7d93\u6fdf\u6709\u6548\u5730\u4f7f\u7528\u85e5\u7269\u3002 \u5728\u4f7f\u7528\u53ef\u80fd\u66f4\u6602\u8cb4\u7684\u4e8c\u7dda\u85e5\u7269\u4e4b\u524d\uff0c\u60a8\u5fc5\u9808\u5617\u8a66\u5df2\u77e5\u5b89\u5168\u6709\u6548\u7684\u4e00\u7dda\u85e5\u7269\u3002 \u8acb\u6aa2\u8996\u7b26\u5408\u9019\u4e9b\u6a19\u6e96\u7684\u85e5\u7269\u6e05\u55ae\uff1a<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.elderplan.org\/files\/2026_steptherapy_updated_10-15-25_accessible\">D \u90e8\u5206\u5206\u6b65\u6cbb\u7642\u6e05\u55ae<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.elderplan.org\/files\/2026_pa-criteria_updated_10-15-25_accessible\">D \u90e8\u5206\u4e8b\u5148\u6388\u6b0a\u6e05\u55ae<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-\u6578\u91cf\u9650\u5236-ql\"><strong>\u6578\u91cf\u9650\u5236 (QL)<\/strong><\/h2>\n\n\n\n<p><strong>\u4ec0\u9ebc\u662f\u6578\u91cf\u9650\u5236\uff1f<\/strong><\/p>\n\n\n\n<p>\u6578\u91cf\u9650\u5236 (QL) \u9650\u5236\u4e86\u6bcf\u6b21\u8655\u65b9\u6216\u5728\u898f\u5b9a\u6642\u9593\u5167\u7684\u627f\u4fdd\u85e5\u7269\u6578\u91cf\u3002 \u5982\u679c\u60a8\u9700\u8981\u7684\u85e5\u7269\u8d85\u904e\u5141\u8a31\u7684\u6578\u91cf\uff0c\u60a8\u7684\u91ab\u751f\u5fc5\u9808\u5411 Elderplan\uff08\u9577\u8001\u8a08\u5283\uff09\u63d0\u4ea4\u4e00\u4efd\u652f\u63f4\u8072\u660e\u3002 \u5728\u60a8\u958b\u5177\u984d\u5916\u6578\u91cf\u7684\u8655\u65b9\u4e4b\u524d\uff0c\u9700\u8981\u7372\u5f97\u6838\u51c6\u3002<\/p>\n\n\n\n<p><strong>\u70ba\u4ec0\u9ebc\u9700\u8981\u6578\u91cf\u9650\u5236\uff1f<\/strong><\/p>\n\n\n\n<p>QL \u662f\u6839\u64da\u88fd\u9020\u5546\u7684\u5291\u91cf\u6307\u5357\u548c\u76ee\u524d\u7684\u91ab\u7642\u5efa\u8b70\u5236\u8a02\u7684\uff0c\u4ee5\u9632\u6b62\u85e5\u7269\u8aa4\u7528\u548c\u6feb\u7528\u3002 \u8d85\u904e\u9650\u5236\u7684\u8655\u65b9\u5728\u914d\u85e5\u524d\u9700\u8981\u7372\u5f97\u6388\u6b0a\u3002<\/p>\n\n\n\n<p><strong>\u5982\u6709\u5fc5\u8981\uff0c\u60a8\u53ef\u4ee5\u7533\u8acb\u67d0\u4e9b\u9650\u5236\u7684\u4f8b\u5916\u8655\u7406\u3002 \u6709\u95dc\u66f4\u591a\u8cc7\u8a0a\uff0c\u8acb\u700f\u89bd<a href=\"https:\/\/www.elderplan.org\/member-benefits\/elderplan-benefits\/prescription-drugs\/prior-authorization\/\">\u5e38\u898b\u554f\u984c\u89e3\u7b54<\/a>\u4e2d\u7684\u4f8b\u5916\u8655\u7406\u90e8\u5206\u3002<\/strong><\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\"><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns vc_row wpb_row vc_row-fluid lfi-full-row vc_custom_1660068779200 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class=\"wp-block-button is-style-outline is-style-outline--4\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.dentaquest.com\/en\/find-a-dentist\/search-results#state=New+York&amp;planType=medicare&amp;plan=NY-ELDCARE&amp;distance=25&amp;lat=40.7127753&amp;lon=-74.0059728&amp;locDesc=New%3Dyork%2C+New+York%2C+100410&amp;currentView=provider&amp;sort=distance&amp;page=1&amp;isSearchEnabled=true&amp;city=New+York\">\u5c0b\u627e\u7259\u91ab<\/a><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-nowrap is-layout-flex wp-container-core-buttons-is-layout-94bc23d7 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--5\"><a class=\"wp-block-button__link wp-element-button\" href=\"\/zh\/member-benefits\/elderplan-benefits\/prescription-drugs\/\">\u5c0b\u627e\u85e5\u7269<\/a><\/div>\n\n\n\n<div class=\"wp-block-button is-style-outline is-style-outline--6\"><a class=\"wp-block-button__link wp-element-button\" href=\"\/zh\/medicare-advantage-plan-options\/plan-materials\/find-a-form\/\">\u5c0b\u627e\u8868\u683c<\/a><\/div>\n\n\n\n<div class=\"wp-block-button is-style-outline is-style-outline--7\"><a class=\"wp-block-button__link wp-element-button\" href=\"\/files\/elderplan-broad-vaccine-network-vaccine-pharmacy-directory_updated_06012022_eng_accessible\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u6d41\u611f\u75ab\u82d7\u85e5\u623f\u6e05\u55ae<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>\u4ec0\u9ebc\u662f\u4e8b\u5148\u6388\u6b0a\uff1f \u4e8b\u5148\u6388\u6b0a (PA) \u662f\u6211\u5011\u7684\u4f7f\u7528\u7ba1\u7406(UM [&hellip;]<\/p>\n","protected":false},"author":21,"featured_media":0,"parent":48,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"class_list":["post-25197","page","type-page","status-publish","hentry"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"zh","enabled_languages":["en","es","zh"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false}}},"acf":[],"jetpack_sharing_enabled":true,"publishpress_future_action":{"enabled":false,"date":"2026-06-02 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