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. Your member ID card will list your formulary. If your member ID card does not have a formulary listed, you have Formulary 1.

Drug Coverage Change Overview for 2025-2026 (applies to formulary 1, 2, and 5)

CDPHP Formulary 1 (Large Group Drug List)

For plans renewing before July 1, 2025

• Search by Drug Name — Formulary 1

• Formulary 1 Updates — a list of the most recent changes.

• Full Formulary 1 — details on tier status, prior authorization requirements, and quantity limits for select drugs.

• Formulary 1: Step Therapy Drug — a list of drugs that require step therapy.

CDPHP Formulary 2 (Small Group, Individual coverage, Essential Plan Drug List)

For plans renewing before July 1, 2025

• Search by Drug Name — Formulary 2

• Formulary 2 Updates — a list of the most recent changes.

• Full Formulary 2 — details on tier status, prior authorization requirements, and quantity limits for select drugs.

• Formulary 2: Step Therapy Drug: — a list of drugs that require step therapy.

NEW - CDPHP Formulary 3 (Large Group Drug List)

For plans renewing July 1, 2025 and thereafter

• Search by Drug Name — Formulary 3 

• Full Formulary 3 — details on tier status, prior authorization requirements, and quantity limits for select drugs. 

NEW - CDPHP Formulary 4 (Small Group, Individual coverage, Essential Plan Drug List)

For plans renewing July 1, 2025 and thereafter

• Search by Drug Name — Formulary 4

• Full Formulary 4 — details on tier status, prior authorization requirements, and quantity limits for select drugs.

CDPHP Formulary 5 (Drug list for self-insured coverage with a 5 Tier benefit design)

• Search by Drug Name — Formulary 5

• Formulary 5 Updates — a list of the most recent changes.

• Full Formulary 5 — details on tier status, prior authorization requirements, and quantity limits for select drugs.

• Formulary 5: Step Therapy Drug — a list of drugs that require step therapy.

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.

For more information about the Medicaid pharmacy benefit transition from CDPHP to NYRx, visit the pharmacy benefit transition webpage.

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.

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