PRESCRIPTION DRUG PRIOR AUTHORIZATION AND FORMULARY EXCEPTIONS

This page is for Commercial Plans (State and Education only.)

Commercial Pharmacy

• Prescription Drug Transition of Care Form
• Prior Authorization Form
• Medicare Advantage Pharmacy Request for Medicare Prescription Drug Coverage Determination Form
• Request for Medicare Prescription Drug Appeal (Redetermination) Form
• Prescription Drug Prior Authorization
• Quantity Limits
• Step Therapy
• Reimbursements

For Generations Medicare Advantage plans, click here.

Prior authorization (PA) and step therapy (ST) 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 877-280-5600 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.

General PA/ST and Formulary Exception Fax Form (This is for Commercial Plans only. For Generations Medicare Advantage plans, click here.)

The above General Fax form is to be used for requesting a drug formulary exception for medications that are not on GlobalHealth’s formulary list or for medications that are on the formulary but require additional review for coverage (i.e., prior authorization, quantity limit or step therapy). Using the General PA/ST and Formulary Exception fax form when a drug specific form is available may result in delays with processing your request.

Select a drug from the list below: