Prescriptions & 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.
Prescription and Pharmacy Information by Plan
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:
Generations Advantage claims
Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing.
These include:
- Hannaford Pharmacies
- CVS Pharmacies
In the network of pharmacies with preferred cost-sharing, members of Generations Advantage Prime and Select, and Access receive medications in Tier 1, Tier 2, Tier 3, Tier 4, and *Tier 6 of the Generations Advantage formulary (or drug list) at lower copays than at pharmacies with standard cost sharing.
*Tier 6 medications apply ONLY to Prime and Select plan members
US Family Health Plan claims
One-time medications or medications that a member needs to begin taking immediately can be filled at:
- Any participating retail pharmacy
Long-term, maintenance medications must be filled through the following pharmacies:
- Martin's Point mail-order pharmacy
Members may receive up to a 90-day supply at these locations (some restrictions apply) for one copayment per prescription.
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.
Generations Advantage | Members
Submit a Prior Authorization request.
Our Medicare Clinical Prior Authorization department representatives are available to take your requests 24 hours a day, 7 days a week.
For Generations Advantage prior authorization, call our Medicare Clinical Prior Authorization department toll-free at:
1-888-296-6961
GA Prior Authorization requsts can also be made online by using the link below:
US Family Health Plan| Members
Submit a Prior Authorization request.
If you are not able to locate the authorization form that you need or have other related questions, please call Provider Inquiry at:
1-888-732-7364
For US Family Health Plan Pharmacy Authorization Status, call:
207-774-5801| ext. 6545
(allow for a 24-hour turnaround for your voice mail inquiry)
Generations Advantage Determinations, Grievances, and Appeals
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.
Grievances & Appeals | Information
For Generations Advantage plan members.
Access the Provider Manual for detailed information on the Generations Advantage Grievances & Appeals process:
Drug Redetermination | Online Request
For Generations Advantage plan members.
To submit a Prescription Drug Denial Redetermination Request online, use the following request form:
Electronic Prescriptions
Martin’s Point mail order pharmacy accepts electronic prescriptions.
Search for us under “Martins Point Mail Order Pharmacy Maine” (for US Family Health Plan members ONLY).
If you are unable to find the Martin’s Point mail order pharmacy 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 when sending prescriptions for US Family Health plan members. This will prevent delays in the delivery of their medication.