Check Drug Lists

What is a Formulary?

A formulary (also known as a drug list) is a list of brand-name and generic drugs (or medications) that are covered under your prescription drug benefit. If you have a question about coverage, pricing, or rules, contact Customer Care using the number on the back of your member card.

Formularies

Medicare / Dual Special Needs Plans (D-SNP)

Visit our Medicare member’s Check Drug Lists to view your plan’s formulary.

Small Group / Individuals and Families

Applies to small groups (plans offered by employers with 100 employees or less), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Univera Healthcare.

Upcoming Changes

Midsize / Large Group

Applies to midsize and large groups (plans offered by employers with more than 100 employees)

Upcoming Changes

Medicaid Managed Care / HARP

Applies to those with Univera Healthcare MyHealthSM, MyHealth PlusSM

As of April 1, 2023, members enrolled in Univera MyHealth and Univera MyHealth Plus receive their prescription medications through NYRx, the Medicaid Pharmacy Program.

Learn more about the transition of the pharmacy benefit from Univera Healthcare MyHealthSM, MyHealth PlusSM to NYRx, the Medicaid Pharmacy Program.

Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.

Child Health Plus

Applies to those with Child Health Plus through Univera Healthcare.

Upcoming Changes

Other Offerings and Programs

Specialty Drug List

Applies to commercial groups (plans offered by employers), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Univera Healthcare, and Child Health Plus through Univera Healthcare.

The following specialty drugs must be purchased from one of our participating specialty pharmacies in order to receive coverage under your prescription drug benefit (for medications that are self-administered).

Mandatory Maintenance Medication List

Some benefit plans require certain medications to be purchased through Express Scripts, Wegmans Home Delivery, or a mail order home delivery pharmacy.

Prior Authorization, Step Therapy, and Quantity Limits

Prior Authorization and Step Therapy

Some prescription medications require prior authorization, step therapy, or both. This is to make sure you have access to safe, effective drug therapy while protecting against inappropriate use and waste.

Prior authorization means you must get approval before you fill your prescription. If you don't get approval, the drug may not be covered. Step therapy means that you may have to try certain drugs to treat your medical condition before we'll cover another drug for that condition. For example, if Drug A and Drug B both treat your condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

Drugs that require prior authorization or step therapy are indicated on our drug list and are also listed in the documents below.

Group Plans (Small, Midsize, and Large)

Applies to groups (plans offered by employers)

Child Health Plus

Applies to those with Child Health Plus through Univera Healthcare

Quantity Limits

For certain drugs, we limit the amount of the drug that we will cover. For example, we provide 30 tablets per prescription for Zocor. Drugs that have quantity limits are indicated on our drug list. Search our online drug lists to find out if a quantity limit applies to your medication or view our list of drugs with quantity limitsOpen a PDF

Request a Review or Exception

To request a review for a drug that requires prior authorization or step therapy, or has a quantity limit, you may:

 

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