2020 Formulary

Important Notice on MAPD HMO Plan Termination Effective March 1, 2020

Effective February 29, 2020, Quality Health Plans of New York (QHPNY) will terminate its contract with the Centers for Medicare and Medicaid Services (CMS).

Quality Health Plans of New York won’t offer Medicare plans after February 29, 2020. This means coverage through Quality Health Plans of New York will end February 29, 2020.

It has been our honor to serve you. Quality of Health Plans of New York would like to thank you for the opportunity and sincerely apologizes for any inconvenience this may cause.

For more information members should refer to the notices recently mailed or call Customer Service at 1 (877) 233-7058 (TTY/TDD: 711). Until March 31st, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. and from April 1 to April 30th, you can call us Monday through Friday from 8:00 a.m. to 8:00 p.m.

You may also call 1-800-MEDICARE (1-800-633-4227). Tell them your plan isn’t going to be offered after February 2020 and you want help choosing a new plan. This toll-free help line is available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

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

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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