Drugs Covered

Independent Health Drug Formularies are lists of drugs that are covered under your plan. Formulary drugs are medications recommended by the Independent Health Pharmacy & Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities and costs.

Essential Plan Formulary

The following information applies to plans offered through the Essential Plan. Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit.

View the 2019 Essential Plan Formulary View the 2018 Essential Plan Formulary

Independent Health's Drug Formulary I

The following information applies to plans offered through large group. Check your summary of benefits to ensure this formulary (Drug Formulary I) is associated with the plan offered to you by your employer prior to using your prescription drug benefit.

View the 2019 Independent Health Drug Formulary I View the 2018 Independent Health Drug Formulary I

Independent Health's Drug Formulary II

The following information applies to plans offered through the NY State of Health: The Official Health Plan Marketplace – for individuals through the Individual Marketplace. This information also applies to Independent Health plans offered to individuals directly, not through the marketplace. Check your summary of benefits to ensure this formulary (Drug Formulary II) is associated with your plan prior to using your prescription drug benefit.

View the 2019 Independent Health Drug Formulary II View the 2018 Independent Health Drug Formulary II

Independent Health's Drug Formulary III

The following information applies to small group plans available directly from Independent Health, as well as those offered through the NY State of Health: The Official Health Plan Marketplace – for small businesses through the Small Business Marketplace. Check your summary of benefits to ensure this formulary (Drug Formulary III) is associated with your plan prior to using your prescription drug benefit.

View the 2019 Independent Health Drug Formulary III View the 2018 Independent Health Drug Formulary III

Independent Health’s FEHB Drug Formulary

The following information applies to plans offered through Federal Employees Health Benefits (FEHB). Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit.

View the 2019 FEHB Drug Formulary View the 2018 FEHB Drug Formulary

Independent Health’s Medicare Advantage Plans

View our Medicare Advantage Plan drug formularies

Have MediSource or Child Health Plus? Independent Health covers the pharmacy benefits associated with your plan.

View the 2019 MediSource (Medicaid) and Child Health Plus Drug Formulary View the 2018 MediSource (Medicaid) and Child Health Plus Drug Formulary

Important pharmacy benefit Information regarding pharmacy benefits for MediSource and Child Health Plus:

  • Please use your Independent Health ID card at the pharmacy to receive your prescriptions, not your Medicaid benefit card.
  • You must use a pharmacy that accepts Independent Health coverage. If your pharmacy does not take Independent Health, you may need to get new prescriptions from your doctor to take to a pharmacy that takes Independent Health.
  • Not every drug will be covered on the formulary. If a medication is not covered, you or your pharmacist may need to talk to your doctor about changing to a medication that is on our formulary.

Pharmacy Coverage for Vaccines for Independent Health’s Medicaid Managed Care Plans: Children (VFC-Eligible) Members And Adults (Non-VFC Eligible) Members

The New York Vaccines for Children (VFC) Program provides no-cost vaccines to underserved populations of children in New York state. To qualify, children must be New York residents who are under 19 years old and are:

  • Enrolled in Medicaid, or
  • Underinsured, or
  • Uninsured, or
  • American Indian or Native Alaskan

Any child who is eligible for this program should receive the vaccines through the VFC, including children who are enrolled in Medicaid Managed Care programs.

Reimbursement
As the vaccine is provided to these members at no cost, Independent Health will not reimburse a pharmacy for the cost of the vaccine. We will, however, reimburse a pharmacy an administration fee when administering the vaccine to one of our members.

To receive the administration fee, pharmacies should bill the NDC for the vaccine as they normally would for our other members. Independent Health will return a response with no reimbursement for the vaccine, but we will include a separate administration fee.

Medicaid Managed Care Members
Independent Health’s Medicaid managed care members can be identified by their BIN number (016557) and by their ID number, which consists of their Medicaid CIN#, preceded by the letter “D”.

If a pharmacy has any questions regarding identifying a VFC eligible member or how to bill the claim, please call our Pharmacy Help Desk at 1-800-993-9898.

How to become a VFC Provider
Pharmacies are able to sign up to become a VFC provider. There are a number of requirements, including inspections, which are handled through the New York State Department of Health (for pharmacies located outside of New York City).

For additional information on the VFC Program, including how to become a provider, visit the VFC website.

Vaccine Coverage for Adult Members (non-VFC Coverage)
For Independent Health’s Medicaid managed care members aged 19 and over, pharmacies should bill the NDC number for the vaccine administered. As the vaccines are not provided at no cost by the VFC program to the pharmacy for these members, the pharmacy will receive reimbursement for both the cost of the vaccine and the administration fee.

Prescription pill bottles

Don’t See Your Drugs Covered?

Fill out our Formulary Exception Form.

Want to Get Your Meds Through the Mail?

Learn how to use our
Mail Order option.

Where Can You Fill a Prescription?

Find a listing of the in-network and chain pharmacies in our National Pharmacy Network.