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.

Retrospective Authorization

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

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