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.

• NEW 2023 Product-specific drug authorization request forms are now available. These forms should be completed and submitted with your request along with supporting medical records.

• For a list of preferred drugs please see our Part B Step Therapy Drug List (PDF)

• Drug-Specific Authorization Forms (fill out and submit with your request)

Authorization Instructions

Prior Authorization

• For prescriptions, please visit our Pharmacy page.

• 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:
  • Non Cardiac CT, MRI, PET and Nuclear Medicine services
  • Call eviCore at 1-888-693-3211 OR use eviCore’s self-service web portal at www.eviCore.com/healthplan/Martins_Point

• 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.