Authorizations

Generations Advantage Part B Step Therapy: Drugs & Biologics Changes for March 1, 2023

  • Prior authorization is required for all Step Therapy drugs, preferred and non-preferred.*
  • *The only preferred drugs not requiring authorization are:
    • Synvisc®, Synvisc-One®, Orthovisc®, and Monovisc®
    • Avastin® is preferred for ocular indications only and does not require authorization
  • Authorizations for dates of service starting on or after March 1, 2023, can be submitted through the Optum Portal beginning February 16, 2023.
  • Authorizations for dates of service before March 1, 2023, must continue to be submitted through ProAuth.

Authorization Instructions

Prior Authorization
  • For mental health/substance abuse services for Generations Advantage Plan members call BHCP at 1-800-708-4532.
  • For mental health/substance abuse services for US Family Health Plan members call BHCP at 1-888-812-7335.
  • Imaging Services for Generation Advantage members ONLY: eviCore manages authorizations for the following advanced imaging services:
  • For both Generations Advantage and US Family Health Plan members, prior authorization may be requested by the member's PCP or by the servicing provider/facility.
    • Prior authorization is not required for emergency care.
    • Prior authorization requests should be submitted at least 14 calendar days prior to the date of service or facility admission.
    • If the servicing provider is not part of the Martin’s Point network, we require a letter of medical necessity (including clinical
      documentation) explaining why the service(s) can only be provided by this specialist.

www.eviCore.com/healthplan/Martins_Point


Retrospective Authorization

Please refer to the Forms and Documents section for more information.

Questions? Read more in the Provider Manual or Contact Us.