Pharmacy claims

What to do if a drug isn't covered

When a prescription drug isn’t covered under your formulary, options are available to health plan members who need a certain drug, or their providers prefer that drug.

Formulary addition request

A doctor can submit for changes, additions, comments or suggestions related to a formulary. Formulary addition requests are usually made by written request to the GHP pharmacy department.

Non-formulary medications

When our formulary doesn’t include a medication that you need — whether it's because of a specific allergy, a specific diagnostic-related need or because the alternative no longer works for you — your doctor may ask the Geisinger Health Plan pharmacy department to make an exception.

Prior authorization

Some medications have added requirements or limits on how they're covered by a health plan. When a medication requires prior authorization, the doctor prescribing it has to get prior approval from GHP before you can fill the prescription. Without prior approval, the health plan may not cover the drug.