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. If your member ID card does not have a formulary listed, you have Formulary 1.
CDPHP Formulary 1 (Large Group Drug List)
For plans renewing before July 1, 2025:
CDPHP Formulary 2
For Small Group and Individual coverage plans renewing before July 1, 2025 as well as Essential Plan through December 31, 2025:
CDPHP Formulary 3 (Large Group Drug List)
For plans with renewal dates July 1, 2025 - December 31, 2025:
Effective upon plan renewal dates beginning January 1, 2026 and thereafter:
CDPHP Formulary 4
For Small Group and Individual coverage plans with renewal dates July 1, 2025 - December 31, 2025:
Effective for Essential Plan beginning January 1, 2026 as well as Small Group and Individual coverage plans with renewal dates beginning January 1, 2026 and thereafter:
CDPHP Formulary 5 (Drug list for self-insured coverage with a 5 Tier benefit design)
CDPHP Child Health Plus Formulary
Medical Benefit Formulary/Prior Authorization Medications
The following guideline includes most, but not all, provider administered injectable medications and pharmaceutical agents.
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