Effective April 1, 2023 the pharmacy benefit for New York State Medicaid Managed Care members will be transitioned to NYRX, the Medicaid Pharmacy Program formerly known as Medicaid Fee-for-Service. For detailed information about this transition please visit the NYRx pharmacy benefit transition website. Helpful Links
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.
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 1-800-364-6331.
Prior Authorization: For prescribers only, for questions regarding prior authorization, call 1-877-872-4716, and to initiate prior authorization requests, fax 1-844-823-5479.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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 844-601-5879.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
Customer Service: For questions regarding policy and coverage information, call 1-866-231-0847 or visit our website: https://www.mybcbswny.com/wny-members/ny-home.html
Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-833-252-0328.
Prior Authorization: Pharmacy preauthorization requests should be submitted by calling 1-866-231-0847 or faxing 1-844-490-4877 for retail prescription drugs, 1-844-493-9206 for medical injectable drugs.
Prescribers can also submit pharmacy authorization requests through our electronic prior authorization (ePA) process with CoverMyMeds. Prescribers can submit requests electronically, check electronic PA status, and upload supporting documents by logging on to https://www.covermymeds.com
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
Customer Service: For questions regarding policy and coverage information, call 1-855-283-2146.
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
Customer Service: For questions regarding policy and coverage information, call 1-800-650-4359.
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 1-800-363-4658.
Blue Choice Health Plan General Pharmacy Benefit Information
Blue Choice Health Plan Medicaid Covered Drugs
Blue Choice Health Plan Prior Authorization Form
Blue Choice Pharmacy Vaccine Billing Guidance
Blue Choice Physician-Administered Drug Policy and Billing Guidance
Physician Dispenser Billing Guidance
Premier Health Plan General Pharmacy Benefit Information
Premier Health Plan Medicaid Covered Drugs
Premier Health Plan Prior Authorization Form
Premier Health Plan Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
Member Services: For questions regarding policy and coverage information, call 1-833-207-3117 or visit our website.
Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-833-252-0328.
Prior Authorization: For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call1-800-450-8753.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
Customer Service: For questions regarding policy and coverage information, call 1-800-650-4359.
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 1-800-363-4658.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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 1-800-364-6331.
Prior Authorization: For prescribers only, for questions regarding prior authorization, call 1-877-872-4716, and to initiate prior authorization requests, fax 1-844-823-5479.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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 844-601-5879.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Non-Enrolled Provider Pharmacy Override Guidance
Physician Dispenser Billing Guidance
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.
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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 2022-11-01. As a best practice, always contact or visit your managed care plan's website to obtain the most current information regarding drug coverage.