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

Initiate coverage determination request here.

Online: Initiate coverage determination request here.

Initiate redetermination request here.

Online: Initiate redetermination request here. 

Prescription Drug Reimbursements Click here

COMMERCIAL PLANS (STATE AND EDUCATION)

Plan Year 2023

Prescription Drug Prior Authorization, Step Therapy and Formulary Exception Fax Form Click here

2023 Prescription Drug Reimbursement Claim Form Click here

Transition of Care Form Click here

Plan Year 2024

Prescription Drug Prior Authorization, Step Therapy and Formulary Exception Fax Form - Coming Soon  

Prescription Drug Transition of Care Form - Coming Soon  

Prescription Drug Reimbursements Click here

Drug Specific forms can be accessed from the list below.