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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  

Prescription Drug Electronic Prior Authorization