Prescriptions and Pharmacies
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. For the latest versions of our plan formularies, please visit:
2023 Formulary Search:
- 2023 Generations Advantage Formulary for Prime, Select, Value Plus and Focus DC.
US Family Health Plan
One-time medications or medications that a member needs to begin taking immediately can be filled at any participating retail pharmacy or at the Martin's Point Health Care Center Pharmacies in Portland, Maine, and Portsmouth, New Hampshire. Long-term, maintenance medications must be filled through the Martin's Point mail-order pharmacy or at the Martin's Point Health Care Center Pharmacies in Portland, Maine, and Portsmouth, New Hampshire. Members may receive up to a 90-day supply at these locations (some restrictions apply) for one copayment per prescription.
Generations Advantage
Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing. These include:
- Hannaford Pharmacies
- CVS Pharmacies
We also have a network of local pharmacies with preferred cost sharing. These include:
Maine
- Community Pharmacies
- Herbert Rexall Pharmacy, Van Buren
- Miller Drug, State Street, Riverside, and Westgate, Bangor, Brewer
- St. John Valley Pharmacy, Fort Kent
- Unity Pharmacy
- Western Maine Pharmacy, Kingfield
- Wilson’s Drug Store, Bath
New Hampshire
- The Medicine Store, Concord
- Roberts Scarlett Pharmacy, New London
In the network of pharmacies with preferred cost-sharing, members of Generations Advantage receive medications in Tier 1, Tier 2, Tier 3, and Tier 4 of the Generations Advantage formulary (or drug list) at lower copays than at pharmacies with standard cost sharing.
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
TRICARE® Drug Prior Authorization
TRICARE Drug Prior Authorization Forms
For US Family Health Plan Pharmacy Authorization Status, please call 207-774-5801, ext. 6545 (please allow for a 24-hour turnaround for your voice mail inquiry).
If you are not able to locate the authorization form that you need or have other US Family Health Plan Pharmacy-related questions, please call Provider Inquiry at 1-888-732-7364.
Generations Advantage Drug Prior Authorization
For Generations Advantage prior authorization call our Medicare Clinical Prior Authorization department toll-free at 1-855-344-0930, Option 6. Our Medicare Clinical Prior Authorization department representatives are available to take your requests 24 hours a day, 7 days a week.
Or you can use the online request link below:
Generations Advantage Drug Prior Authorization Request
Generations Advantage Determinations, Grievances and Appeals
- Information on the Generations Advantage Grievances and Appeals process including drug coverage determinations and appeals.
- Submit a Prescription Drug Denial Redetermination Request online.
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. Click here to learn how to enroll or opt-out. (PDF)
Electronic Prescriptions
Martin’s Point pharmacies accept electronic prescriptions. Search for us under the following names from within your Electronic Medical Records (EMR) system:
• “Martins Pt. Mail Order Pharmacy Maine” (for US Family Health Plan members ONLY)
• “Martins Pt. Portland Clinic Maine Pharmacy”
• “Martins Pt. Portsmouth Clinic New Hampshire Pharmacy”
If you are unable to find the Martin’s Point pharmacy names 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 rather than our Portland, ME or Portsmouth, NH clinic pharmacies when sending prescriptions for US Family Health plan members. This will prevent delays in the delivery of their medication.
Contact Information
Martin's Point Health Care
Attn: Pharmacy Department
PO Box 9746
Portland, ME 04104-5040
Martin's Point Health Care Mail-Order Pharmacy-US Family Health Plan
Phone: 1-800-707-9853
Fax: 207-828-2483
Martin's Point Clinic Pharmacy – Portland
Phone: 207-791-3756 or 1-888-408-8281
Fax: 207-828-2495
Martin's Point Clinic Pharmacy – Portsmouth
Phone: 603-436-0562 or 1-800-603-0562
Fax: 603-427-6155
Martin's Point Generations Advantage
Part D
CVS/Caremark
Claims: 1-888-296-6961