Prior Authorization Forms
PRESCRIPTION DRUG PRIOR AUTHORIZATION AND FORMULARY EXCEPTIONS
Prior authorizations, formulary exceptions, quantity limits and step therapy requirements encourage safe, cost-effective medication use by allowing coverage when certain conditions are met. GlobalHealth benefits require covered medications to be prescribed in adherence to FDA-approved and manufacturer-recommended indications, strength, dosage, treatment duration, etc.
When possible, submit prior authorization requests prior to treatment.
A member or member’s representative may request a prior authorization to be initiated. Members can contact GlobalHealth’s Customer Care at 844-280-5555 for assistance or select from the below forms to provide to their physician. The prescribing physician will be required to complete the form and submit additional documentation such as clinical notes, lab values, etc. that support your prior authorization request.
Generations Medicare Advantage plans
Prescription Drug Coverage Determination request form Click here
To initiate an Electronic Prescription Drug Coverage Determination Click here
Prescription Drug Coverage Redetermination request form Click here
To initiate an Electronic Prescription Drug Coverage Redetermination Click here
Prescription Drug Reimbursements Click here
COMMERCIAL PLANS (STATE AND EDUCATION)
Plan Year 2024/2025
Prescription Drug Prior Authorization, Step Therapy and Formulary Exception Fax Form