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Prescription Drug Formularies

Is your prescription covered under your plan? The Formulary Search Tool can give you the answers you need.

Martin’s Point Generations Advantage uses a prescription drug formulary—a list of covered drugs that have been selected in consultation with a team of health care providers.

Generations Advantage plan formularies represent the prescription therapies believed to be a necessary part of a quality treatment program. 

Below you will find information relating to your plan's prescription drug formulary. 


Table of Contents:
  1. Drug Formulary Information & Search Tool
  2. Formulary Search Tips
  3. Changes to the Drug Formulary


2024 Drug Formularies

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 one of our network pharmacies, and other related plan rules are followed.

Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available.

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More Prescription and Pharmacy Resources:
Below you will find links to the formulary (the list of covered drugs) for each plan - available through the Formulary Search Tool and Formulary PDF downloads:

Drug Formulary | Online Search Tool

Members can find detailed coverage information for a specific prescription drug online.

Get to the Formulary Search Tool for your Generations Advantage plan here:

PRIME PLAN
FORMULARY SEARCH TOOL
  
SELECT PLAN
FORMULARY SEARCH TOOL
  
VALUE PLUS PLAN
FORMULARY SEARCH TOOL
  
ACCESS PLAN
FORMULARY SEARCH TOOL

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Drug Formulary| PDF File Download

Use the Comprehensive Drug Formulary to find detailed coverage information for medications.

A downloadable PDF copy for each Generations Advantage plan is available for members to download and print at home:

PRIME PLAN
2024 FORMULARY (PDF)
  
SELECT PLAN
2024 FORMULARY (PDF)
  
VALUE PLUS PLAN
2024 FORMULARY (PDF)
  
ACCESS PLAN
2024 FORMULARY (PDF)
Drug Formulary Search Tips

Helpful tips and step-by-step instructions for searching the formulary for a specific prescription drug can be found here:d

Formulary Search—A Step-by-Step Guide

Step 1: Enter name of medication into the box.
(2 character minimum)

Step 2: Wait for a list to appear. This list will contain all the covered strengths for the drug.

Step 3: Choose the strength you want and press enter.

Step 4: A box that says “ADD TO LIST” appears to the right of the medication name.

Step 5: Click on the box.

Step 6: A chart will present 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

If the medication you are searching for is not covered by the benefit, this message will appear in red above the medication name: “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."

To see alternative medications that are covered on the formulary, click on the blue “Alternatives Available” link to the right of the medication name.

Changes to the Formulary

Our formulary is reviewed and updated regularly by medical and pharmacy professionals. A formulary may change during the year if we remove drugs from our formulary, add a prior authorization requirement, add quantity limits and/or step therapy restrictions on a drug, and/or 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 at least 30 days before any of these changes become 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.

Have questions? We're here to help.

If you have questions about your plan, you can talk to a Member Service Representative by calling 1-866-544-7504.

Our representatives are available from 8am–8pm, seven days a week.