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Pharmacy coverage - GHP Family

GHP Family provides very specific details about how your pharmacy and medical benefits work.

Find out which drugs are covered

GHP Family has what is known as a formulary, which is a list of drugs covered under your plan. You can search the formulary to see if your prescriptions are covered.

You can print a copy of the GHP Family Formulary (updated 9/28/2021 | effective 10/1/2021) or you can request a printed copy over the phone.

Specialty medications

Specialty drugs are medications used to treat complex diseases. 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. 

  • Use of the Specialty Pharmacy Drug Program is mandatory only when medication will be self-administered by the member at home. Use of the Specialty Pharmacy Drug Program is not mandatory if the physician elects to buy the medication and bill GHP Family for the cost.

  • If GHP Family is the secondary insurance specialty pharmacy does not apply

  • Specialty medications may require prior authorization. Information is available under "Find out which drugs are covered" at the top of this page or by calling 855-552-6028.

If you are taking a specialty medicine or if you have a question about finding a specialty pharmacy, call GHP Family Pharmacy Services at 855-552-6028 or 570-214-3554 from 8 a.m. to 5 p.m. Monday, Tuesday, Thursday and Friday and from 8 a.m. to 8 p.m. on Wednesdays. 

Transition policy

As a new member, you may be taking drugs that aren’t on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited.

This means that you may need permission to obtain a drug that is not listed on the formulary. For example, you may need a prior authorization from us before you can fill your prescription. In this case, you should speak with your doctor to decide if you should switch to an appropriate formulary drug or request a formulary exception. While you talk to your doctor to determine your best option, we will cover your current drugs during the first 60 days of your membership.

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.

No limit on prescriptions

GHP Family doesn't limit the number of prescriptions a member can receive each month. Members having difficulty managing multiple prescriptions can receive help from a GHP Family pharmacist. Our pharmacists work with you and your physician to make it easier for you to stay on the medications you need.

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.

GHP Family customer service

Customer service rep

If you have questions about your pharmacy or medical benefits, call the GHP Family Customer Service Team: 800-552-6028 (TTY/TDD: 711)

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

Related information

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