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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.

From time to time, our 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 that affect 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

2022 pharmacy prior authorization policies standard Rx | $0 deductible Rx (updated June 28, 2022/effective September 1, 2022)
2022 step therapy policies standard Rx | $0 deductible Rx (updated June 28, 2022/effective September 1, 2022) | Part B list & criteria  (updated May 17, 2022/effective July 15, 2022)

Changes to the Geisinger Gold standard Rx formulary (effective September 1, 2022)
Changes to the Geisinger Gold $0 deductible formulary (effective September 1, 2022)

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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 9/1/2022) 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

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

  1. You can ask GHP Family Pharmacy Customer Service for a list of similar drugs that are on the GHP Family formulary. Show the list to your doctor to see if one of these drugs will work for you.
  2. Your physician can ask GHP Family for approval of your current drug through a prior authorization. See our prior authorization criteria.

Specialty medications

Specialty drugs are medications used to treat complex disease. GHP Family uses PerformRx’s Specialty Pharmacy Network to ensure GHP Family members have access to Specialty Medications. PerformRx Specialty allows members to use any contracted specialty pharmacy to obtain any specialty medication the pharmacy stocks.

PerformRx will allow members to receive medications from out-of-network pharmacies when the drug(s) are not available at a network pharmacy (“limited distribution” or when the drug maker limits what pharmacy can dispense their medication) or if the network pharmacy cannot serve the GHP Family member in time to prevent harm to the member.

The GHP Family Specialty Drug List document is a list of all specialty drug and specialty pharmacy information.
 

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.

Related information

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