Pharmacy
Peach State Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Peach State Health Plan members. Peach State Health Plan covers prescription medications and certain over-the-counter medications with a written order from a Peach State Health Plan provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
Use our Preferred Drug List (PDL) to find more information on the drugs that are covered.
Prior Auth Criteria Search
Please use the search function or select View All to locate the drug specific Peach State Health Plan prior authorization form that should be used when submitting an authorization request.
Preferred Drug Lists
- Preferred Drug List (PDL) (PDF)
- Family Planning Preferred Drug List (PDL) (PDF)
- Inter-Pregnancy Care Preferred Drug List (PDL)(PDF)
- Appropriate Use and Safety Edits (last updated 04/2015) (PDF)
- PSHP GA 2019 Q3 PDL Update (effective 9/23/2019) (PDF).
- PSHP GA 2019 Q1 PDL Update (effective 03/25/2019) (PDF).
- PSHP GA 2018 Q4 PDL Update (effective 12/28/2018) (PDF).
- PSHP GA 2018 Q3 PDL Update (effective 09/24/2018) (PDF)
- PSHP GA 2018 Q2 PDL Update (effective 06/29/2018) (PDF)
- PSHP GA 2018 Q1 PDL Update (effective 03/30/18) (PDF)
- PSHP GA 2017 Q4 PDL Update (effective 12/26/17) (PDF)
- PSHP Preferred DIABETIC SUPPLIES: Alcohol and Lancets (effective 06/01/16) (PDF)
Quick Reference List
- Topical Corticosteroids (PDF)
- Antidepresseants (PDF)
- Asthma-COPD Agents (PDF)
- Atypical Antipsychotics (PDF)
- Cholestrol Lowering Agents (PDF)
- Diuretics (PDF)
- Gastro Agents (PDF)
- Injectable Antidiabetic Agents (PDF)
- Oral Antidiabetic Agents (PDF)
JSON Preferred Drug Lists
- Preferred Drug List (PDL) (JSON)
- Family Planning Preferred Drug List (PDL) (JSON)
- Inter-Pregnancy Care Preferred Drug List (PDL) (JSON)
PDL Archive
- PSHP-GA Biopharmaceutical Pharmacy Program 2015 (PDF)
- PSHP GA 2017 Q3 PDL Changes (effective 9/25/17) (PDF)
- PSHP GA 2017-Q2 PDL Changes (effective 6/5/17) (PDF)
- PSHP GA 2017-Q2 PDL Changes (part 2 – effective 6/25/17) (PDF)
Pharmacy Forms
- PSHP PHARM RSV Referral Form 2017-2018 (PDF)
- Medication Prior Authorization Request – Envolve Pharmacy Solutions (updated 08/01/2019) (PDF)
- Specialty Medication Prior Authorization Form 2015 (PDF)
Pharmacy Notifications
Pharmacy Notification Archive
- PSHP PHARM PHARMACY ImmunityConnect Notification (PDF)
- Hydrochlorothiazide RECALL (Member) (PDF)
- Hydrochlorothiazide RECALL (Provider) (PDF)
- Auvi-Q RECALL (Member) (PDF)
- PSHP-USS COMMON PDL NSAID (060513) (PDF)
- Intrauterine Devices (IUDs) No Longer Require Prior Notification (PDF)
- New Specialty Pharmacy: Acaria – Provider Notice (PDF)