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 
Effective May 1, 2021 the pharmacy benefit for New York State Medicaid Managed Care members will be transitioned to NYS Medicaid Fee-for-Service (FFS). For detailed information please visit the pharmacy carve-out website .
• Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service must be enrolled in FFS in order to continue to serve Medicaid Managed Care members. Information on how to enroll can be found in the October 2020 Medicaid Update on p.10.
• Medicaid FFS pharmacy program can be found on the NYS Medicaid Pharmacy Program site
• FFS preferred drug program and prior authorization requirements can be found on the Magellan Medicaid Administration site
• The NYS Medicaid Pharmacy List of Reimbursable Drugs can be found on the eMedNY site
Affinity by Molina Healthcare
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
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 844-601-5879.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Health Now, Inc/BCBS of Western NY
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
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
EmblemHealth
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
Excellus
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
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
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Empire Blue Cross Blue Shield Health Plus
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
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Univera Healthcare
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
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
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
Molina Healthcare
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
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 844-601-5879.
General Pharmacy Benefit Information
Pharmacy Vaccine Billing Guidance
Physician-Administered Drug Policy and Billing Guidance
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.
- For more information on the NY State Medicaid fee for service program visit the New York State Medicaid site.
- For formulary information on the NY State Medicaid fee for service program visit the eMedNY site.
- For more information on the NY State Medicaid Prior Authorization Programs please visit the Magellan Medicaid Administration site.
- For more information on Medicaid Managed Care visit the New York State Managed Care site.
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 2022-05-19. As a best practice, always contact or visit your managed care plan's website to obtain the most current information regarding drug coverage.