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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 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, please perform a drug look-up search.

Managed Care Plans

Affinity Health Plan Amida Care Health Now Capital District Physicians Health Plan
Crystal Run Emblem Health Excellus BCBS Health Plan Fidelis Care
HealthFirst Empire Blue Cross Blue Shield Health Plus Independent Health MetroPlus Health Plan
MVP Total Care UnitedHealthcare Visiting Nurse Service of NY Choice Health Plans
WellCare Health Plans Your Care    

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

Prior Authorization Form

Behavioral Health Transition


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

Behavioral Health Transition

Behavioral Health Phone: 1-800-556-0689


Drug Look-Up

Health Now, Inc/BCBS of Western NY

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

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


Drug Look-Up


Crystal Run

Customer Service: For questions regarding policy and coverage information, call 1-844-638-6506.

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 1-800-788-2949.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


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 Behavioral Health Transition

Blue Choice Health Plan Prior Authorization Form


Premier Health Plan General Pharmacy Benefit Information

Premier Health Plan Medicaid Covered Drugs

Premier Health Plan Behavioral Health Transition

Premier Health Plan 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

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition (for provider)


Drug Look-Up


Empire Blue Cross Blue Shield Health Plus

Member Services: For questions regarding policy and coverage information, call 1-800-300-8181 or visit our website.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-844-367-6116.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call1-800-450-8753.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


Beacon Health Strategies Provider Relations
Phone: 855-371-9228
Email: provider.relations@beaconhs.com


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 1-800-364-6331.

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

Prior Authorization Form

Behavioral Health Transition


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 1-800-788-2949.

Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call 1-800-788-2949.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition        866-362-3368


Drug Look-Up


Your Care

Customer Service: For questions regarding policy and coverage information, call 1-855-315-3372.

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, call 1-800-922-1557.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Behavioral Health Transition


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

Prior Authorization Form

Behavioral Health Transition


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. It is available from 8:00 a.m. through 8:00 p.m., Monday through Friday and from 9:00 a.m. to 1:00 p.m., on Saturday.

Please let us know if you’re having difficulty with this website, if any of the links are broken, or if you have a suggestion for additional content by clicking here: contact 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. This information was last updated on August 05, 2016. As a best practice, always contact or visit your managed care plan's website to obtain the most current information regarding drug coverage.