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.
Formulary information is provided through the MedicarePlanRx platform and updated annually in coordination with Martin’s Point.
For the most current formulary coverage and prescribing information for your patient’s plan, maintained and updated by Express Scripts, please visit:
Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing.
These include:
In the network of pharmacies with preferred cost-sharing, members of Generations Advantage Prime and 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.
*Tier 6 medications apply ONLY to Prime and Select plan members. These medications are allowed a 100 day supply.
One-time medications or medications that a member needs to begin taking immediately can be filled at:
Long-term, maintenance medications must be filled through the following pharmacies:
Members may receive up to a 90-day supply at these locations (some restrictions apply).
Certain drugs require prior authorization. This means that the provider will need to submit a request for approval on the members' behalf to 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.
Our Medicare Clinical Prior Authorization department representatives are available to take your requests 24 hours a day, 7 days a week:
GA Prior Authorization requests can also be made online by using the links below:
If you cannot locate the authorization form that you need or have other related questions like the status of an authorization, please call Provider Inquiry at:
All prior authorization forms can be accessed in the Forms & Documents library:
.
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.
Access detailed information on the Grievances & Appeals process:
For Generations Advantage health plan members only
To submit a Prescription Drug Denial Redetermination Request online, use the following request form:
.
Martin’s Point mail order pharmacy accepts electronic prescriptions.
Search for us under “Martins Point Mail Order Pharmacy Maine” (for US Family Health Plan members ONLY).
If you are unable to find the Martin’s Point mail order pharmacy 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 when sending prescriptions for US Family Health plan members. This will prevent delays in the delivery of their medication.
Martin's Point Mail Order Pharmacy
Phone: 1-800-707-9853
Fax: 207-828-2483