Your New York Child Health Plus drug coverage

How your pharmacy benefit works

Your state’s Drug List shows drugs your Child Health Plus plan covers. You can get drugs that are:

• Listed on your state’s Drug List (also called a formulary).
• Prescribed by a doctor who works with your state program.
• Filled at a Pharmacy that works with your state program.

Some drugs may have rules, like:

• Age limits
• Limits on how much you can get
• Limits on how soon you can fill the drug again
• The generic or biosimilar version must be used
• You must try one drug before another (preferred drugs)
• Prior authorization (your doctor must ask for approval first)

You pay nothing for covered drugs.

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