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Prior Authorization Forms

Medicare Advantage Prior Authorization

For Generations Medicare Advantage plans, please call (844) 449-0360 or click here for Coverage Determination and Prior Authorization forms.

PRESCRIPTION DRUG PRIOR AUTHORIZATION AND FORMULARY EXCEPTIONS

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.

Select a drug from the list below: