Your Molina Healthcare of New York Essential Plan drug coverage

How your pharmacy benefit works

Two Convenient Ways to Fill Prescriptions

•  At your local pharmacy You can use your prescription benefit ID card at most chain and independent pharmacies across the country. Find a participating pharmacy near you using the Pharmacy Locator.
• Through the Caremark Mail Order Pharmacy If your doctor has prescribed a drug for you to take for a long time (also called a Maintenance Medication), you may be able to have up to a 90-day supply delivered directly to your home or location of choice from our mail order pharmacy by using the following form: Pharmacy Mail Order Form

Specialty Medications

These are high-cost, injectable, oral, infused or inhaled medications that are typically self-administered.

Specialty Guideline Management (SGM)

SGM is our utilization management program; administered by CVS Caremark, that helps ensure appropriate utilization for specialty medication based on currently accepted evidence-based medicine guidelines. SGM is designed to ensure safety and efficacy while preventing off-guideline utilization. Prescribers may call (866) 814-5506 to enroll patients in the Specialty plan design.

Comprehensive Contraception Coverage Act (CCCA)

You are covered for all forms of contraceptive drugs, devices and products approved by the U.S. Food and Drug Administration (FDA). This includes all FDA-approved over-the-counter contraceptive products as prescribed or as otherwise authorized under state or federal law. You are also permitted to receive an entire 12-month supply of a contraceptive at once.

Where the FDA has approved one or more therapeutic and pharmaceutical equivalent versions of a contraceptive drug, device or product, Affinity Health Plan is not required to include all of the therapeutic and pharmaceutical equivalent versions in its formulary, so long as at least one is included and covered without cost-sharing.

Your contraceptive coverage is provided without any cost-sharing, including any deductible, coinsurance or copayment. Prior authorization, step therapy protocols, or quantity limits on a 12-month supply are not permitted for your contraceptive coverage.

Your cost depends on your drug and your plan.

If you need help, call Member Services at (800) 223-7242 (TTY: 711).