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.
Preferred Drug Lists
- Preferred Drug List (PDL) – 04/2017
- Family Planning Preferred Drug List (PDL) – 10/2015
- Appropriate Use and Safety Edits (last updated 04/2015)
- PSHP GA 2017 Q3 PDL Changes (effective 9/25/17)
- PSHP GA 2017-Q2 PDL CHANGES (part 2 – effective 6/25/17)
- PSHP Preferred DIABETIC SUPPLIES: Alcohol and Lancets (effective 06/01/16)
PDL Archive
- PSHP-GA Biopharmaceutical Pharmacy Program 2015
- PSHP GA 2017-Q2 PDL CHANGES (effective 6/5/17)
- PSHP-GA 2016 – Q2 PDL Change (effective 06/01/16)
- PSHP-GA 2016 – Q1 PDL Change (effective 03/28/16)
- PSHP-GA 2015 – Q4 PDL Change (effective 12/28/15)
- PSHP-GA 2015 – Q3 PDL Change (effective 9/30/15)
- PSHP-GA 2015 – Q2 PDL Change (effective 6/30/15)
- PSHP-GA 2015 – Q1 PDL change (effective 3/16/15)
Pharmacy Forms
- PSHP PHARM RSV Referral Form 2015-2016
- Medication Prior Authorization Request – US Script (PDF)
- Specialty Medication Prior Authorization Form 2013
Pharmacy Notifications
- Auvi-Q RECALL (Member)
- Hydrochlorothiazide RECALL (Provider)
- Hydrochlorothiazide RECALL (Member)
- PSHP-USS OPR Provider Notice (effective 1/1/2014)
- PSHP-USS COMMON PDL NSAID (060513)
- PSHP PHARM PHARMACY ImmunityConnect Notification
Pharmacy Notification Archive
- Intrauterine Devices (IUDs) No Longer Require Prior Notification
- New Specialty Pharmacy: Acaria – Provider Notice
- Synagis Notification 2015-2016
Maximum Allowable Cost