Information for Providers

Pharmacy

» Common Prescriptions (PDF).  This chart includes the most commonly prescribed drugs for members of the US Family Health Plan. Drugs are categorized by tier to show providers which drugs will result in the lowest co-pay for the member.

Authorization Information

We are pleased to provide you with this information relating to authorization requirements for US Family Health Plan members.

On this page you can download PDF files of each of these documents. You can also view this information by clicking on the links in the menu on the right.

» Authorization Process Summary (PDF). For your reference, we have developed a summary of the fundamental aspects of our authorization process.

» Updated Authorization Requirements (PDF). The requirements grid has been updated to include additional services and comments. New additions and changes are printed in bold for quick identification.

» Durable Medical Equipment Requirements (PDF). Changes to this table are printed in bold. Requirements related to specialized wheelchairs and mobility devices have been clarified.

» Medications Requiring Prior Authorization (PDF). We have re-formatted this list to include brand names and generic descriptions of medications requiring authorization. Please note that consistent with TRICARE policy, these medications require specific prior authorization to be covered. If not specifically authorized, these medications (as well as related services) cannot be covered by the US Family Health Plan.

» New Authorization Request Form (PDF). The Authorization Request Form has been modified to streamline the request process. Please discard any prior versions and submit requests on the new form.

Providers now have the ability to check status of Claims, Eligibility, and Authorizations online. To learn more or to sign up for this service, please contact our Provider Inquiry Department at the number below.

We appreciate your continued support of the US Family Health Plan and our authorization process. Please remember that authorization requests are to be submitted in advance and that services requiring authorization are denied if they have not been approved by the Martin's Point Medical Services Department.

If you have questions or comments, please contact the Provider Inquiry Department at 1-888-732-7364 or your Network Representative.