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: 2025 Formulary
- Generations Advantage 2025 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 | 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 links 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)
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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:
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:
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Pharmacy Resource Guides
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.
Guides for the 2026 Plan Year
Guides for the 2025 Plan Year
Coming Soon