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Prescription drug coverage updates and recalls

From time to time, a health insurance plan’s formulary—the list of drugs selected by a health insurance company that represents medications believed to be a necessary part of a quality treatment program—is updated to add or remove medications. We’ve provided a list of past and present changes to help you determine if changes have been made concerning your prescriptions.

Changes to Geisinger Health Plan formularies

Check this page regularly to keep up with the latest changes to Geisinger Health Plan’s formularies.

New drugs are added to the formularies on a regular basis. You can find these additions in our member newsletters, and they’re also posted here in PDF format for your convenience. 


Geisinger Gold policies

2024 pharmacy prior authorization policies standard Rx | $0 deductible Rx (updated April 25, 2024/effective May 1, 2024) 

2024 step therapy policies standard Rx | $0 deductible Rx (updated April 25, 2024/effective May 1, 2024) | Part B list & criteria (updated April 19, 2024/effective May 22, 2024) 

Changes to the Geisinger Gold standard Rx formulary (updated March 26, 2024/effective April 1, 2024)

Changes to the Geisinger Gold $0 deductible formulary (updated March 26, 2024/effective April 1, 2024)

Find Covered Drugs and Pharmacies:


Commercial, Marketplace and GHP Kids policies

You can view or print a copy of the Commercial, Marketplace and GHP Kids pharmacy benefit prior authorization policies

GHP Family policies

You can print a copy of the GHP Family Formulary (effective 5/1/2024) or you can request a printed copy over the phone.

Geisinger Health Plan, like other Medicaid Managed Care Organizations, follows the Statewide Preferred Drug List (PDL). The Statewide PDL is a list of preferred drugs developed by the Department of Human Services’ (DHS) Pharmacy and Therapeutics Committee. Medications not on the PDL follow the GHP Family Formulary. Click to view the Statewide Preferred Drug List (PDL).

If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change (30 days for employer coverage and GHP Family; 60 days for other plans) before the change becomes effective, or at the time the member requests a refill of the drug.

If the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

Prior authorization

GHP Family requires your physician to get prior approval for certain drugs.  This means that your prescriber will need to get approval from GHP Family before you fill prescriptions for these drugs. Without this approval, GHP Family will not pay for the drug.  

If you need prior authorization of your medication, you have two options:

  1. Ask for a list of similar medications on the GHP Family Formulary. Show the list to your doctor. They can tell you if one will work for you.

    Call GHP Family Pharmacy Customer Service at 855-552-6028 or 570-214-3554 (PA Relay 711).

    Hours:
    Monday, Tuesday, Thursday, Friday: 8 a.m. – 7 p.m.; Wednesday: 8 a.m. – 8 p.m.; Saturday: 8 a.m. – 2 p.m.

  2. Your doctor can ask GHP Family to approve your current drug through a prior authorization. See our Geisinger policy.

    Click to view the Statewide Preferred Drug List (PDL) – Prior authorization criteria

Specialty medications

Do you need specialty medications? GHP Family uses Navitus Specialty Pharmacy Network. That means you can use any network specialty pharmacy. Find the list of medications here.

You can use an out-of-network pharmacy: 

  • If the medications you need aren’t at a network pharmacy. This is called “limited distribution.” It’s when the drug maker only lets some pharmacies dispense their medication.
  • If a network pharmacy can’t give you medications in time to prevent harm.

Prescription drug recalls

Geisinger Health Plan promptly identifies and notifies members and their prescribing physicians when the FDA  notifies us of a Class I or Class II drug recall. We send notifications to members who received the recalled medication using their pharmacy benefits.

Class I recall
This type of recall is in cases where there is a reasonable probability that use of, or exposure to, the medication will cause serious adverse health effects or death.

Class II recall
With this class of recall, a medication has been found to cause temporary or medically reversible adverse health consequences or in remote cases, serious adverse health effects.

The FDA website provides news about recent drug recalls, updates on market withdrawals of medications and safety alerts.

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Related information

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