Prescriptions & Pharmacies
Our health plan formularies are frequently updated to keep pace with new clinical data and evolving drug classes. Pharmacies will dispense a generic medication when available.
Our goal is to maintain a clinically sound, broad formulary that will help drive generic utilization which lowers pharmacy costs for your patients. We distribute revised formularies to our members on an annual basis and will inform members and providers when changes are made.
For the latest versions of our plan formularies, please visit:
Generations Advantage
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US Family Health Plan
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In the network of pharmacies with preferred cost-sharing, members of Generations Advantage Prime, Select, and Access receive medications in Tier 1, Tier 2, Tier 3, Tier 4, and Tier 6 of the Generations Advantage formulary (or drug list) at lower copays than at pharmacies with standard cost sharing.
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 | PA Requests
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:
US Family Health Plan | PA Requests
If you are not able to locate the authorization form that you need or have other related questions, please call Provider Inquiry at:
1-888-732-7364
For US Family Health Plan Pharmacy Authorization Status, call:
207-774-5801 | ext. 6545
(allow for a 24-hour turnaround for your voice mail inquiry)
All USFHP Prior Authorization forms can be found here:
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. (PDF)
Grievances & Appeals | Information
Access the Provider Manual for detailed information on the Generations Advantage Grievances & Appeals process:
Drug Redetermination | Online Request
To submit a Prescription Drug Denial Redetermination Request online, use the following request form:
Martin’s Point pharmacies accept electronic prescriptions.
Search for us under the following names from within your Electronic Medical Records (EMR) system:
- “Martins Point Mail Order Pharmacy Maine” (for US Family Health Plan members ONLY)
- “Martins Point Portland Clinic Maine Pharmacy”
- “Martins Point Portsmouth Clinic New Hampshire Pharmacy”
If you are unable to find the Martin’s Point pharmacy names as listed above, please contact your EMR system administrator and request a download of the latest list of e-prescribing pharmacies from Surescripts.®
The State of Maine allows electronic prescriptions for controlled substances. EMR software companies must take additional security and technology steps to comply with the Drug Enforcement Administration’s Interim Final Rule. Please confirm with your software vendor that they are certified by the DEA before transmitting prescriptions for controlled substances.
New York state providers, please be sure to select “Martins Pt. Mail Order Pharmacy Maine” within your EMR system rather than our Portland, ME or Portsmouth, NH clinic pharmacies when sending prescriptions for US Family Health plan members. This will prevent delays in the delivery of their medication.