Information About Formularies 2023

What is a Formulary?

Martin’s Point Generations Advantage uses a formulary. A formulary is a list of covered drugs selected by Martin’s Point Generations Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Martin’s Point Generations Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Martin’s Point Generations Advantage network pharmacy, and other plan rules are followed.

Can the Formulary (List of Covered Drugs) Change?

Our formulary is reviewed and updated on a regular basis by medical and pharmacy professionals. A formulary may change during the year if we: remove drugs from our formulary add prior authorization add quantity limits and/or step therapy restrictions on a drug move a drug to a higher cost-sharing tier Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during that same coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released.

We must notify you if a drug you are taking is changing at least 30 days before the change becomes effective. At the time you request a refill, you will receive a 30-day supply of the drug. Martin’s Point Generations Advantage covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

How Do I Search The Formulary
(List of Covered Drugs)?

1. Enter name of medication into the box.
2. Wait for a list to appear.  This list will contain all the covered strengths for the drug.
3. Choose the strength you want and press enter.
4. A blue box that says “ADD TO LIST” appears to the right of the medication name.
5. Click on the blue box.
6. A chart will populate that contains the following:
   • Medication name and strength
   • Brand or Generic indicator
   • Tier the medication is covered on (this will help you determine your cost share)
   • Any special requirements for coverage of the medication (e.g. Prior Authorization, Quantity Limits, etc)
   • Some medications are not available by mail order.  This will be noted in the medication description on the formulary
7. If the medication that is being searched for is not covered by the benefit a message stating “The drug you have selected is not covered by the plan you have chosen.  Please select a different strength or click the Alternatives Available link if listed below”.   This will appear in red above the medication Name.
8. To see alternative medications that are covered on the formulary click on the blue “Alternatives Available” link to the right of the medication name.