Pharmacy

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.

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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:

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A list of Quick Resource Guides for Generations Advantage and the US Family Health Plan, as well as other helpful documents can be found below.