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.
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 preauthorization before covering quantities that exceed the established limit.
For the latest versions of our plan formularies, please visit:
- US Family Health Plan: 2024 Formulary
- Generations Advantage 2024 Formularies: Prime | Select | Access | Value Plus.
Drug Prior Authorizations
Certain drugs require prior authorization. This means that a member or their provider will need to get approval from Martin's Point Health Care before the prescription is filled.
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.
GENERATIONS ADVANTAGE
DRUG PRIOR AUTHORIZATIONS
Our Medicare Clinical Prior Authorization department representatives are available to take your requests 24 hours a day, 7 days a week.
For Generations Advantage prior authorization call our Medicare Clinical Prior Authorization department toll-free at 1-888-296-6961.
GA Prior Authorization requsts can also be made online by using the link below:
TRICARE® US FAMILY HEALTH PLAN
DRUG PRIOR AUTHORIZATIONS
If you are not able to locate the authorization form that you need or have other US Family Health Plan Pharmacy-related questions, please call Provider Inquiry at 1-888-732-7364.
For US Family Health Plan Pharmacy Authorization Status, please call 207-774-5801, ext. 6545 (please allow for a 24-hour turnaround for your voice mail inquiry).
All USFHP Prior Authorization forms can be found here:
Generations Advantage Determinations, Grievances and Appeals
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.
Grievances and appeals information relating to GA Pharmacy requests is available here:
PRESCRIPTION DRUG GRIEVANCES & APPEALS INFORMATION
Access the Provider Manual for detailed information on the Generations Advantage Grievances & Appeals process, including drug coverage determinations/appeals:
SUBMIT A DRUG REDETERMINATION REQUEST ONLINE
To submit a Prescription Drug Denial Redetermination Request online, use the following request form: