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This website is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by different Medicaid and Family Health Plus health care plans. While pharmacy benefits and participating pharmacies vary among health plans, all plans maintain their own web sites and customer service call centers.

To use this website, you should first check your health plan identification card and match it to the one presented on this website. By clicking on the appropriate identification card/logo you will be provided with contact numbers and links to your health plan's website including links to prior authorization (PA) forms and drug look-up options. If you do not have your health plan identification card or do not know what health plan you are enrolled in, call the Medicaid Helpline at 1-800-541-2831 from 8am through 8pm, Monday through Friday and from 9am to 1pm on Saturday.

Each managed care plan has its own list of covered drugs (called a formulary). If you would like to find out if a drug is covered, perform a drug look-up search.

Managed Care Plans

Affinity Health Plan Amida Care Health Now Capital District Physicians Health Plan
Emblem Health Excellus BCBS Health Plan Fidelis Care HealthFirst
HealthPlus Amerigroup Hudson Health Plan Independent Health MetroPlus Health Plan
MVP Total Care UnitedHealthcare Univera Community Health
Visiting Nurse Service of NY Choice Health Plans WellCare Health Plans    

Affinity Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-866-247-5678.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-877-432-6793.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up

Amida Care

Customer Service: For questions regarding policy and coverage information, call 1-646-757-7000.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-824-0898.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-753-2851.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Drug Look-Up

BCBS of Western New York

Customer Service: For questions regarding policy and coverage information, call 1-877-327-1395.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-866-544-7948.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, fax to 1-866-221-5784.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Formulary Updates

Prior Authorization Form

Drug Look-Up


Capital District Physicians Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-388-2994.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-866-693-4611.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-518-641-3784.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


EmblemHealth

Customer Service: For questions regarding policy and coverage information, call 1-800-447-8255.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-888-447-7364.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-877-362-5670.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


Excellus

Customer Service: For questions regarding policy and coverage information, call 1-800-724-5033.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-788-2949.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-724-5033.

Blue Choice Health Plan General Pharmacy Benefit Information

Blue Choice Health Plan Medicaid Covered Drugs

Blue Choice Health Plan Family Health Plus Covered Drugs

Premier Health Plan General Pharmacy Benefit Information

Premier Health Plan Medicaid Covered Drugs

Premier Health Plan Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


Fidelis Care

Customer Service: For questions regarding policy and coverage information, call 1-888-343-3547.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-888-343-3547.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


healthfirst

Customer Service: For questions regarding policy and coverage information, call 1-855-298-2485.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-877-433-7643.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up

Health Plus Amerigroup

Customer Service: For questions regarding policy and coverage information, call 1-800-600-4441.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-454-3730.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-454-3730.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


Hudson Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-339-4557.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-687-0707.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-687-0707.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


Independent Health

Customer Service: For questions regarding policy and coverage information, call 1-800-501-3439.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-993-9898.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-247-1466 ext. 5311.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Formulary Exception Form

Drug Look-Up

MetroPlus Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-303-9626.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-877-433-7643.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up

MVP Health Care

Customer Service: For questions regarding policy and coverage information, call 1-800-852-7826.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-922-1557.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, fax to 1-800-376-6373.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up

Visiting Nurse Service of New York Choice Health Plans

Customer Service: For questions regarding policy and coverage information, call 1-866-469-7774.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-877-433-7643.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Specialty Pharmacy Information

Prior Authorization Form

Drug Look-Up

Total Care

Customer Service: For questions regarding policy and coverage information, call 1-800-223-7242.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-877-728-0177.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-753-2851.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up

 
 
 

UnitedHealthcare Community Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-493-4647.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-877-305-8952.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-310-6826.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


Univera Community Health

Customer Service: For questions regarding policy and coverage information, call 1-800-494-2215.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-788-2949.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-724-5033.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Prior Authorization Form

Drug Look-Up


WellCare

Customer Service: For questions regarding policy and coverage information, call 1-800-288-5441.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-288-5441.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-288-5441.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Family Health Plus Covered Drugs

Covered Drugs Updates - effective November 1, 2014

Covered Drugs Updates - effective August 26, 2014

Prior Authorization Form

Covered Over-the-Counter Drugs

Drug Look-Up

Contact Information

For questions regarding your eligibility or to find out which managed care plan you are enrolled in, you may call the Medicaid Helpline at 1-800-541-2831 from 8am through 8pm, Monday through Friday and from 9am to 1pm on Saturday.

If any of the links you click fail to direct you to a specific page, please email PPNO@health.state.ny.us.

Disclaimer

The New York State Department of Health (NYSDOH) obtains drug formulary information from Medicaid participating managed care plans on a quarterly basis. Please note NYSDOH publishes the drug formulary information as it is received. As a best practice, always contact or visit your managed care plan's website to obtain the most current information regarding drug coverage.