Covered Drug List

Updates to the Covered Drug Lists

Check below for information about recent changes to the list of drugs covered under your formulary, including tier status, prior authorization requirements, and quantity limits for select drugs.

Your member ID card will list your formulary on the back of the card.

Medical Benefit Formulary/Prior Authorization Medications

The following guideline includes most, but not all, provider administered injectable medications and pharmaceutical agents.

• Medical Benefit Formulary/Prior Authorization Medication List

Medicaid Drug Coverage

Beginning April 1, 2023, all members enrolled in CDPHP Medicaid will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

To learn more about NYRx, the Medicaid Pharmacy Program, visit the New York State Department of Health NYRx website, where information for both for members and providers is also available.

Practitioner Dispensing Guidance

Medicaid Drug Coverage Policies

• Avastin Coverage Policy

• Herceptin Coverage Policy

• Perjeta Coverage Policy

• Xolair Coverage Policy

• Drugs to Treat Duchenne Muscular Dystrophy (DMD) Coverage Policy