2019 Formulary

Formulary Information

The QHPNY Pharmacy Formulary is a list of prescription drugs that are selected by the plan with help from a team of doctors and pharmacists. The list meets set requirements and has been approved by Medicare.

Generally, QHPNY covers any drug listed in our Formulary as long as:

  • The drug is medically necessary
  • The prescription is filled at a network pharmacy
  • All other plan rules are followed

It’s important to know that we may make certain changes to our Formulary during the year that could affect you. Types of changes may include:

  • Adding or removing drugs from the Formulary
  • Adding prior authorizations, quantity limits, and/or step-therapy restrictions on a drug
  • Moving a drug to a higher or lower cost-sharing tier

Quality Health Plans of New York gives 60-day notice regarding removal or change in the preferred or tiered cost-sharing status of a Part D drug.

Drug Lists and Utilization Management

To search these documents Windows users hit CTRL F, Mac users, Command F.

Formulary for All Plans
Step Therapy Criteria
Prior Authorization Criteria
Formulary Addendum

Find a Drug

The QHPNY drug list is updated regularly. It’s easy to see if your drugs are covered when prescribed by your doctor.

Use our search tool to check if a drug is covered by QHPNY. You can also verify quantity limits, dosage strength and other drug related information. The search function allows you to search for a drug by entering the drug name or by the first letter of the drug name.  

If your drug isn’t covered, please click Here to learn how to request a coverage determination.
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