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 1/29/2021) or you can request a printed copy over the phone.
Specialty drugs are medications used to treat complex diseases. Specialty medications can only be filled by certain pharmacies in the GHP Family network. These medications usually require specialized handling and monitoring. Specialty medications have the words “Specialty Drug” next to them in the formulary.
The GHP Family Specialty Drug List document is a list of all specialty drug information.
- The first column is the drug name. This shows the name of the medications that are included in the program.
- The second column indicates if prior authorization is needed. If prior authorization is needed, your doctor will need to obtain prior authorization from GHP Family before you are able to receive your medication.
- The final column lists which pharmacies carry each medication. The key on the final page provides the details for the pharmacy codes lists. You can speak to your doctor about these pharmacies and whether you have a pharmacy use preference.
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.
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.
If you need prior authorization of your drug, you have two options:
- 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.
- 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.
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