How to request an expedited prior authorization: 24 or 72 hours

To get a prior authorization expedited, the prescriber states that the standard timeframe could seriously jeopardize the patient's life, health or ability to regain maximum function. A Medicare Part D plan then decides a drug request within 24 hours; Medicare Advantage, Medicaid, CHIP and employer plans decide an urgent request for services within 72 hours.

The same test runs through Medicare Part D, Medicare Advantage, Medicaid managed care and employer group health plans under ERISA. Pharmacy benefit managers handle it their own way: CVS Caremark, Express Scripts and MedImpact put an urgent box on the request form, and Optum Rx takes urgent requests by phone.

How do you request an expedited prior authorization?

An expedited prior authorization is requested in four steps: the prescriber's statement that the standard timeframe could seriously jeopardize the patient, the urgent mark the plan asks for, the plan's urgent route, and a record of when the plan received the request.

1. The prescriber or physician indicates that waiting for a standard decision could seriously jeopardize the patient's life, health or ability to regain maximum function.
2. The request carries the urgent mark the plan asks for: the expedited or urgent box on the CVS Caremark, Express Scripts or MedImpact form, or "Urgent" or "Expedite" on page one where a plan's manual asks for it, as Wellmark's does.
3. The request goes by the plan's urgent route, which for Optum Rx is a phone call to 1-800-711-4555.
4. The plan's clock starts when the plan receives the request, so the time a faxed request was delivered is the time to record.

The fax routes for Humana, Aetna and UnitedHealthcare are listed on the pages for Humana's prior authorization fax numbers, Aetna's prior authorization fax numbers and UnitedHealthcare's prior authorization fax number.

What makes a request urgent, and who can ask?

A prior authorization request is urgent when the standard timeframe could seriously jeopardize the patient's life, health or ability to regain maximum function, and the enrollee, a prescriber, a physician or a provider can ask for expedited review, depending on the program. Medicare, Medicaid managed care and employer group health plans share that test.

In Medicare Part D, the enrollee or the enrollee's prescriber may ask the plan to expedite a coverage determination (42 CFR 423.570). A prescriber may give oral or written support for an enrollee's request. When the prescriber makes or supports the request and indicates that risk, the plan must expedite it. The expedited path excludes requests for payment of drugs already furnished.

In Medicare Advantage, an enrollee or any physician, affiliated with the plan or not, may ask for an expedited organization determination. 42 CFR 422.570 requires the plan to grant it when a physician indicates the same risk.

Medicaid managed care expedites a decision when a provider indicates, or the plan determines, that the standard timeframe could seriously jeopardize the enrollee's life, health or ability to attain, maintain or regain maximum function (42 CFR 438.210).

Employer group health plans under ERISA follow the federal claims rule at 29 CFR 2560.503-1. Its pre-service claim, a benefit the plan conditions on approval in advance of medical care, describes a prior authorization request. Any claim that a physician with knowledge of the claimant's condition determines is urgent is treated as a claim involving urgent care.

Medicare Part D asks for no exact wording. CMS's Parts C and D appeals guidance says a prescriber does not have to use the exact words of the Part D standard for the plan to process a request as expedited. The same guidance bars a plan from taking or threatening punitive action against a physician who acts on behalf of or supports an expedited request.

Which clock applies: 24 hours or 72 hours?

The 24-hour clock applies to Medicare Part D drug requests, and the 72-hour clock applies to urgent requests for items and services in Medicare Advantage, Medicaid managed care, CHIP and employer group health plans. The table sets each program's clock beside the rule that sets it.

Part D plans give notice within 24 hours after receiving an expedited request or 72 hours after receiving a standard one, per CMS's Part D coverage determinations page. For an exception request, the clocks begin only when the plan receives the prescriber's supporting statement. CMS guidance also bars a plan from stretching its timeframe by dispensing a temporary supply of the drug.

A Medicare Advantage plan decides an expedited request as expeditiously as the enrollee's health requires and no later than 72 hours after receipt. 42 CFR 422.572 allows an extension of up to 14 calendar days only in the situations it lists. Standard decisions under 42 CFR 422.568 take 7 calendar days for an item or service subject to prior authorization, beginning on or after January 1, 2026, and 14 calendar days for one that is not.

CMS-0057-F requires impacted payers, other than qualified health plan issuers on the federally facilitated exchanges, to send expedited decisions within 72 hours and standard decisions within 7 calendar days. CMS lists the impacted payers as Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and qualified health plan issuers on the federally facilitated exchanges. The exchange issuers sit outside these timeframes, because the rule did not change their prior authorization timelines. CMS's prior authorization FAQ says the requirements cover medical items and services, excluding drugs, and that response time is measured in calendar time.

CMS says the rule's operational provisions generally begin January 1, 2026, with exact compliance dates that vary by type of payer. Medicaid managed care plans decide standard requests within state time frames of no more than 7 calendar days for rating periods that start on or after that date. 42 CFR 457.495 sets 72 hours and 7 calendar days for CHIP, or lets a state follow its existing law on prior authorization.

CMS-0062-P, proposed in April 2026, would set drug prior authorization timeframes, including 24 hours for expedited and 72 hours for standard drug requests at qualified health plan issuers on the federal exchanges. Its compliance dates are proposed from October 1, 2027. A proposed rule binds no payer unless CMS finalizes it.

What does the prescriber attest, and how do you mark the fax?

The prescriber attests that applying the standard review timeframe may seriously jeopardize the patient's life, health or ability to regain maximum function, and the fax is marked with the form's expedited or urgent box, or with "Urgent" or "Expedite" on page one where the plan's manual asks for it. The table gives each form's urgent marking in the form's own words.

A signature beside a checked box on CVS Caremark's Global Prior Authorization Form or Express Scripts' Medicare coverage determination form is the prescriber's own certification of the standard. The Express Scripts form also tells the enrollee that when the prescriber indicates waiting 72 hours could seriously harm their health, the plan will automatically give a decision within 24 hours. MedImpact's July 2026 Prior Authorization Request Form puts an Urgent box on the page for the prescriber to check.

Health plans can set marking rules of their own. Wellmark's Medicare Advantage provider manual asks for "Urgent" or "Expedite" on the first page of a faxed urgent organization determination request. It defines an expedited pre-service request as one where the provider believes the standard timeframe could place the member's life, health or ability to regain maximum function in serious jeopardy.

Should an urgent request go by phone or by fax?

An urgent request goes by the route the plan or pharmacy benefit manager names for urgent requests: a phone call at Optum Rx, and a marked form at CVS Caremark, Express Scripts and MedImpact. Optum Rx's prior authorization guidelines say to call 1-800-711-4555 for urgent requests, and its general prior authorization form says to fax only non-urgent ones.

Medicare Part D plans take expedited requests either way. CMS guidance requires each plan's expedited process to designate an office or department that receives verbal and written requests, with a telephone and a fax number. The processing timeframe for an expedited request begins when the appropriate department receives it.

Under CMS-0057-F, the 72-hour and 7-calendar-day clocks apply whether a request arrives through an API, a portal, fax, phone or another channel. A faxed request's clock runs from its receipt, and the delivery record is what shows that moment; how to tell if a fax went through names the five facts on a fax's record that settle it.

What if the plan refuses to expedite or misses the deadline?

A Medicare Part D plan that refuses to expedite a request decides it within the standard 72 hours, counted from the day it received the expedited request, and a Part D plan that misses an expedited deadline has made an adverse coverage determination. After a refusal, the plan gives the enrollee and the prescriber prompt oral notice, then delivers equivalent written notice to the enrollee within 3 calendar days.

A request filed as standard can be moved up. CMS guidance lets a provider ask the plan to change a request's review priority after it is filed, and the plan starts the expedited clock when it receives the physician's request to expedite.

A missed deadline sends the request outside the plan. 42 CFR 423.572 then requires the plan to forward the request to the Independent Review Entity within 24 hours of the deadline's expiration.

What happens when an urgent request is missing information?

An employer group health plan that receives an urgent claim missing information must say what is missing no later than 24 hours after receipt and give the claimant at least 48 hours to supply it, while under CMS-0057-F a payer's request for more documentation leaves the clock running. For a complete urgent claim, the ERISA rule sets the decision at as soon as possible and no later than 72 hours after the plan receives it.

Part D exception requests run the other way: the 24-hour and 72-hour clocks begin only when the plan receives the prescriber's supporting statement, so a request sent without that statement waits for the statement before its clock starts.

How do you send urgent requests from a HIPAA fax account?

A Fax Pigeon account sends the plan's form and the supporting records together as one PDF, uploaded as it is from the browser or from email. With the cover sheet optional, the plan's own form, its urgent box checked, can lead the fax. Every delivered fax gets delivery proof. The plan's decision arrives in the shared inbox, where it can be assigned to the person tracking the request.

* Official sources (CMS, the Code of Federal Regulations, Optum Rx, CVS Caremark, Express Scripts, MedImpact, Wellmark) were read on October 20, 2026. Fax Pigeon prices and plan terms as of October 20, 2026.