Pharmacy

Our health plan formularies are frequently updated to keep pace with new clinical data and evolving drug classes. Our goal is to maintain clinically sound, broad formularies that help drive generic utilization which lowers pharmacy costs for your patients.

Important Notice! Providers who prescribe drugs for Medicare or Medicare Advantage patients must be enrolled in (or validly opted-out of) Medicare. Because of a new Medicare requirement, it is crucial for your patients’ health that you enroll in Medicare (or validly opt out, if appropriate). Please do so as soon as possible. A delay on your part could result in your Medicare patients not being able to obtain drugs you prescribe for them. Click here to learn how to enroll or opt-out.

Drug Pre-Authorizations

Certain drugs require pre-authorization. This means that a member or his or her provider will need to get approval from Martin's Point Health Care before the prescription is filled by calling our Provider Inquiry team at 1-888-732-7364. Step therapy is also used to provide safe, clinically-effective and cost-effective medication in drug categories that have multiple agents with comparable therapeutic efficacy. This means that these medications are only covered if the member has already tried certain medications that did not work.

For certain drugs, we may limit the amount of the drug that we will cover. The limit does not prevent providers from prescribing larger quantities if appropriate, but we will require pre-authorization before covering quantities that exceed the established limit.

Health Plan Formularies

For the latest versions of our plan formularies, please visit:

US Family Health Plan Formulary

Generations Advantage Formulary

USFHP Drug Pre-Auth Forms (A - C)
USFHP Drug Pre-Auth Forms (D - I)
USFHP Drug Pre-Auth Forms (J - P)
USFHP Drug Pre-Auth Forms (Q - V)
USFHP Drug Pre-Auth Forms (X - Z)
Generations Advantage Determinations, Grievances and Appeals
Provider Manual: Pharmacy

For more information on our pharmacy policies and procedures, please review that section of our Provider Manual.

Pharmacy Contact Information
Questions? Please call 1-888-732-7364.