Pharmacy

Our health plan formularies are frequently updated to keep pace with new clinical data and evolving drug classes. Our goal is to maintain clinically sound, broad formularies that help drive generic utilization which lowers pharmacy costs for your patients.

For certain drugs, we may limit the amount of the drug that we will cover. The limit does not prevent providers from prescribing larger quantities if appropriate, but we will require pre-authorization before covering quantities that exceed the established limit.

For the latest versions of our plan formularies, please visit:

Drug Prior Authorizations

Certain drugs require prior authorization. This means that a member or his or her 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

For TRICARE prior authorization call our Provider Inquiry team at 1-888-732-7364.

TRICARE Prior Authorizations

Generations Advantage Drug Prior Authorization

For Generations Advantage prior authorization call our Medicare Clinical Prior Authorization Department toll-free at 1-888-296-6961. 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 button below.

Generations Advantage Prior Authorization Requests

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.Click here to learn how to enroll or opt-out.

Additional questions? Read more in the Provider Manual or Contact Us.