Where to Document Prior Authorization Justification on a Prescription
Prior authorization justification should be documented in the prescription's "Notes" or "Comments" field, which is the designated free-text area on both paper and electronic prescriptions for communicating additional clinical information to the pharmacy.
Primary Documentation Location
The free-text "Notes" field on prescriptions serves as the appropriate location for prior authorization justification 1, 2. This field allows prescribers to communicate clinical rationale and medical necessity information that pharmacies need to process prior authorization requests 3.
What to Include in the Notes Field
When documenting for prior authorization, include:
- Specific diagnosis or ICD-10 code that justifies the medication 4
- Failed medication trials (drug names, dates, and reasons for discontinuation) 4
- Contraindications to alternative therapies that would typically be required first 4
- Patient-specific clinical factors that necessitate this particular medication or dosage 4
- Relevant laboratory values or test results supporting medical necessity 4
Critical Pitfalls to Avoid
Do not place patient directions (Sig) information in the Notes field 1, 2. Research shows that 2.8% of prescriptions inappropriately contain dosing instructions in the Notes field, creating workflow disruptions and requiring pharmacist callbacks 1. Patient directions belong exclusively in the structured Sig field 2.
Approximately 10% of prescriptions contain quality-related events in free-text fields that pose patient safety risks 2. Keep Notes content focused solely on clinical justification, not dosing instructions 1, 3.
Electronic vs. Paper Prescriptions
For electronic prescriptions, use the designated "Notes to Pharmacist" or "Comments" field in your EHR or e-prescribing system 1, 2. About 0.95% of electronic prescriptions contain inconsistent information between structured and free-text fields, so ensure your justification doesn't contradict other prescription elements 3.
For paper prescriptions, write the prior authorization justification clearly in the "Notes" or "Additional Instructions" section, separate from patient directions 4.
Documentation in the Medical Record
Simultaneously document the complete prior authorization rationale in the patient's medical record 4. This should include:
- The treatment target and expected benefits 4
- Discussion of risks and alternatives 4
- Why this specific medication is medically necessary 4
- Patient's understanding and agreement with the plan 4
This medical record documentation serves as the comprehensive justification, while the prescription Notes field contains abbreviated key points for the pharmacy 4.