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Click the categories below for important pharmacy documents and resources.
Billing Medicaid Pharmacy LTC/SNF Claims (PDF)
Pharmacy Vaccine Coverage and Billing Guide for Medicaid, CHP and HARP (PDF)
HealthierLife (HARP) Coverage and the Behavioral Health Carve-in: July 2, 2018 (PDF)
Notice on the 2018 Flu Season Medications (PDF)
Requesting Synagis for Fidelis Care Members (PDF)
Authorized Generic vs. "Typical" Generic: What is the Difference? (PDF)
What is Biosimilar? (PDF)
American Society of Clinical Oncology Statement: Biosimilars in Oncology (PDF)
2019 Drug Formulary (PDF)
2019 Formulary Quick Reference Guide (PDF)
2020 Formulary (PDF)
2019 Formulary (PDF)
2020 Step Therapy Criteria (PDF)
2020 Prior Authorization (PA) Criteria (PDF)
2019 Step Therapy Criteria (PDF)
2019 Prior Authorization (PA) Criteria (PDF)
Medication Request Form for Medicaid, CHP, and Qualified Health Plans (PDF)
Opioid Prior Authorization Form (PDF)
Hepatitis C Prior Authorization Form (PDF)
HIV Prior Authorization Form (PDF)
Medicare Medication Request Form (PDF)
Medicare Electronic Drug Coverage Determination Form
New York State Department of Health standardized prior authorization form (PDF)
Acaria Health Specialty Medication Referral Form (PDF)
CVS Caremark Specialty Pharmacy Fax Enrollment Form (PDF)
Coram Infusion Services - Pegfilgrastim Products Enrollment Form (PDF)
Coram Infusion Services - Infliximab Enrollment Form (PDF)
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