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Formularies and Pharmacies

Prescription drug coverage is an important part of your Medicare Advantage plan decision process. It is important to review the formulary, or list of covered drugs, included with your plan and make sure that the medicine you take is on the formulary and at what cost.

2026 Formulary Changes
Starting in 2026: Our Individual Medicare Advantage plans will include either a standard or enhanced formulary. It’s important that you confirm which formulary your Medicare Advantage plan includes and then make sure any medicine you take is on the formulary. You can view the 2026 formularies below.  

View the following formularies to check which drugs are included:

Prior Authorization
Some drugs require you (or your physician) to get prior authorization.

Step Therapy Criteria
In some cases, Independent Health requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition:

Formulary Quantity Limits
Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified:

View the following formularies to check which drugs are included:

Prior Authorization Criteria
Some drugs require you (or your physician) to get prior authorization. 2026 Prior Authorization Criteria not included are currently pending CMS review.

Step Therapy Criteria
In some cases, Independent Health requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition.

Quantity Limit Criteria
Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified.

Plan Transition Process: If you are new to the plan, we can help you transition when your current drugs are not on the formulary or your ability to get your drugs is limited.

You are covered both locally and nationally with our extensive pharmacy network. For the full list of participating locations, view our pharmacy directory:

Find the participating pharmacies near you.

You may be eligible to have 90-day supplies of your maintenance medication delivered to your door through a mail order pharmacy. These pharmacies will ship your prescription at no cost, which could save you time and money.

We offer mail order pharmacy services to our members through two partners:

  • ProAct Pharmacy Services*: Register online or by calling 1-866-287-9885 (TTY: National 711 Relay Service)
  • Wegmans Home Delivery Pharmacy: Register by calling 1-888-205-8573 (TTY: National 711 Relay Service)

Learn more and find helpful tips to start using this free benefit.

* ProAct Pharmacy Services does not accept EPIC (NY State EPIC is a secondary pharmacy insurance coverage for Medicare Part D members over 65 years old).

 

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Questions? Call Us.

(716) 250-4401 or
1-800-665-1502
(TTY: 711)

Hours:
October 1 – March 31:
Monday – Sunday
8 a.m. – 8 p.m.

April 1 – September 30:
Monday – Friday
8 a.m. – 8 p.m.

Disclaimer

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Y0042_C7173
Last Updated 10/1/2025

© Independent Health Association, Inc.

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