Medicaid Drug Coverage
Select Plan (Medicaid) members receive their pharmacy benefit through CDPHP.
Formulary & Drug Lists for Medicaid Members
On December 22, 2021, Governor Hochul signed Chapter 720 of the Laws of 2021. This law amends Social Services Law and the Public Health Law, in relation to medication for the treatment of substance use disorders. Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance-use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance-use disorder. Prescriptions written outside of accepted guidelines may be subject to prior authorization.
Formulary & Drug Lists for Medicaid Members
-
Medicaid Formulary (Drug List)
A formulary is a list of covered drugs. The Medicaid formulary is a useful reference to assist practitioners in selecting clinically appropriate and cost-effective drug therapies.
-
Medicaid Formulary Updates
The Medicaid Formulary Updates includes drug products were reviewed and acted upon by the CDPHP Pharmacy and Therapeutics Committee for Medicaid Formulary.
-
Medicaid Over-The-Counter (OTC) Drug List
The CDPHP Medicaid Over-The Counter (OTC) list represents select over the counter medications or products that may be covered with a prescription and at a network participating pharmacy. Quantity limits may apply.
-
Medicaid Prior Authorization Request Form for Prescriptions
The Medicaid Prior Authorization Request Form for Prescriptions is to be completed by prescribing doctors when providing prior authorization or when requesting a formulary exception.
Medicaid Drug Coverage Policies
Avastin Coverage Policy
Herceptin Coverage Policy
Perjeta Coverage Policy
Xolair Coverage Policy