Pharmacy forms and resources
Geisinger Gold (Medicare):
- Erythropoietin Stimulating Agents (ESA) Authorization Form
- Geisinger Gold/Medicare Vaccine Coverage
- Geisinger Gold Nonpar Provider Appeal Process Form
- Hepatitis C Pharmacy Benefit Drug Authorization Form
- Medical Benefit Outpatient Drug Authorization Form
- Medical Drug Prior Authorization List (Commercial/Marketplace/Medicare/CHIP)
- Online Prior Authorization Portal (PromptPA)
- Opioid Cumulative Morphine Equivalent Dose (MED) Authorization Form
- Universal Pharmacy Benefit Drug Authorization Form
Geisinger Health Plan/Geisinger Marketplace (Commercial):
- Erythropoietin Stimulating Agents (ESA) Authorization Form
- Hepatitis C Pharmacy Benefit Drug Authorization Form
- Medical Benefit Outpatient Drug Authorization Form
- Medical Drug Prior Authorization List (Commercial/Marketplace/Medicare/CHIP)
- Non-Preferred Buprenorphine Pharmacy Benefit Drug Authorization Form
- Online Prior Authorization Portal (PromptPA)
- Opioid Cumulative Morphine Equivalent Dose (MED) Authorization Form
- Specialty Drug List
- Universal Pharmacy Benefit Drug Authorization Form
GHP Family (Medical Assistance):
- Medical Benefit Outpatient Drug Authorization Form
- Medical Drug Prior Authorization List (GHP Family - Medicaid)
- Online Prior Authorization Portal (PromptPA)
- Search Geisinger Covered Drugs
- Specialty Drug and Pharmacy List
- Universal Pharmacy Benefit Drug Authorization Form
Statewide PDL forms:
- Search Statewide Preferred Drug List
- Acne Agents, Oral
- Acne Agents, Topical
- Alzheimers Agents PEAP
- Analgesics, Non-Opioid Barbiturate Combinations PEAP
- Analgesics, Opioids Long-Acting PEAP
- Analgesics, Opioids Short-Acting PEAP
- Androgenic Agents PEAP
- Antibiotics- GI and Related Agents
- Antidepressants, Other PEAP
- Antifibrotic Respiratory Agents
- Antihemophilia Agents PEAP
- Antihyperuricemics - Krystexxa PEAP
- Antipsychotics PEAP
- Antivirals- CMV
- Benzodiazepines PEAP
- Bile Salts - Cholbam, Ocaliva
- Blood Glucose Meters and Test Strips PEAP
- Bone Density Regulators PEAP
- Botulinum Toxins PEAP
- Colony Stimulating Factors PEAP
- Continuous Glucose Monitoring Factors
- COPD Agents- Daliresp
- Cytokine and CAM Antagonists PEAP
- Dupixent PEAP
- Enzyme Replacements, Gaucher Disease PEAP
- Erythropoiesis Stimulating Agents
- Estrogens
- GI Motility, Chronic
- Growth Hormones PEAP
- Hepatitis C Agents
- Hereditary Angioedema Agents PEAP
- Hypoglycemics- Incretin Mimetics-Enhancers
- Immunomodulators, Atopic Dermatitis
- Immunosuppressives, Oral - Lupkynis PEAP
- Intra-Articular Hyaluronates PEAP
- Iron Chelating Agents PEAP
- Lipotropics, Other
- Macular Degeneration Agents PEAP
- Migraine Acute Treatment Agents
- Migraine Prevention Agents
- Monoclonal Antibodies - Anti-IL, Anti-lgE, Anti-TSLP
- Multiple Sclerosis PEAP
- Natalizumab
- NSAIDs - Ketorolac PEAP
- Obesity Treatment Agents
- Oncology Agents, Oral PEAP
- Opioid Use Disorder Treatments
- Pituitary Suppressive Agents, LHRH PEAP
- Potassium Removing Agents PEAP
- Proton Pump Inhibitors Less Than 6 y.o. PEAP
- Pulmonary Arterial Hypertension Agents Oral and Inhaled
- Stimulants and Related - Other PEAP
- Stimulants and Related Agents - Provigil, Nuvigil, Sunosi, and Wakix 01-01-20
- Thalidomide and Derivatives PEAP
- Thrombopoietics PEAP
- Ulcerative Colitis Agents
- Urea Cycle Disorder Agents PEAP
- VMAT2 Inhibitors PEAP
Content from General Links with modal content