MVP and CVS Caremark
MVP’s prescription drug coverage is provided through CVS Caremark®, MVP’s Pharmacy Benefit Manager.
With thousands of participating pharmacies, including all major pharmacy chains, mail order, and specialty pharmacy services, access to helpful online tools and unique savings programs, MVP’s prescription benefits make it easy to find and manage your prescriptions.
- NY Rx/Drug Search—For Individual and consumer plans sold through the NYSOH, directly through a broker or MVP (Off-Exchange)
- Find a Pharmacy—Search more than 69,000 retail pharmacies, including all major pharmacy chains, mail order and specialty pharmacy services, and more
- 2018 Preventive Drug List (PDF)—List of covered preventive drugs as of January 2018; applies to New York and Vermont
See the full list of generic and name brand drugs covered by MVP Health Care plans that offer prescription drug coverage.*
- 2019 MVP Commercial/Child Health Plus Formulary (PDF) —Applies to large groups; plans offered by employers with greater than 100 employees, MVP Child Health Plus, and Administrative Services Only plans.
- 2019 MVP Federal Employee Formulary (PDF) —Applies to Federal Employee Health Benefits program.
- 2019 MVP Marketplace Formulary (PDF) —Applies to individuals who purchase their health plan on their own from New York State of Health—including the Essential Plan—or Vermont Health Connect or who purchase the plan directly from MVP. Also applies to small group employers with 100 employees or less.
- 2019 MVP Medicaid Formulary (PDF) —Applies to Medicaid plans.
- MVP Medicaid Formulary Changes (effective 6/1/2018) (PDF)
- 2019 MVP Medicare Part D Individual Plan Formulary (PDF) —Applies to individuals who purchase their Medicare Advantage plan coverage directly from MVP
- 2019 MVP Medicare Part D Employer-Based Plan Formulary (PDF) —Applies to individuals whose Medicare plan coverage is offered through a former employer or union group
*This information relates to the Prescription Drug Formularies generally, and may not describe your particular coverage. Check your Certificate of Coverage or Summary Plan Description for specific benefits, limitations and exclusions.
Manage Your Prescriptions
Members can sign in to manage prescriptions, check drug cost and coverage, view or refill mail order prescriptions, get tips on how to save money and more. MVP members can also sign in to take advantage of CVS Caremark’s full suite of helpful tools.
If you have questions about your pharmacy benefits, the CVS Caremark Customer Care team can help explain your prescription coverage, 24 hours a day, 7 days a week.
- Commercial/Select Care: 1-866-284-7134
- Exchange: 1-800-378-9295
- Medicaid: 1-866-832-8077
- TTY: 1-800-231-4403
Find information on drug recalls and updates.
Frequently Asked Questions
What is a generic drug?
A generic drug is a copy that is the same as a brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use. For example, ibuprofen is the generic for both Motrin® and Advil®.
What if my physician does not write the prescription so I can get a generic drug?
While the use of generic drugs is encouraged to help you save money, you are not required to receive a generic drug. You will pay more for brand name drugs when there is a generic equivalent available. Generally, generic drugs are covered at your lowest tier co-payment and brand name drugs that have a generic equivalent are covered at your highest tier co-payment. If your physician feels that a brand name drug is the right choice for you, you will have a higher tier co-payment. Some of MVP’s prescription benefits may require you to pay the difference in cost between the generic and the brand name drug plus your Tier 1 co-payment if you receive a brand name drug when there is a generic equivalent available.
Can I order prescriptions through the mail?
CVS Caremark is MVP’s contracted Pharmacy Benefit Manager (PBM) and also our mail order pharmacy vendor for most of our health plans. This service is available if your prescription is filled on a regular basis, your prescription drug benefit includes mail order, and the medication you take is available through the CVS Caremark Mail Service Pharmacy. The mail order benefit allows you to buy qualified maintenance drugs at a savings to both you and MVP.
Are there any additional requirements on prescription drugs?
For certain prescription drugs, MVP Health Care has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members. Certain drugs may need prior authorization, have a formulary exception, or require step therapy. Quantity limits may also apply.
If you have questions on additional drug requirements, call 1-866-832-8077.
How do I obtain specialty drugs?
Some prescription drugs must be obtained through CVS Specialty. CVS Specialty handles high touch, high cost drugs for unique and complex medical conditions and delivers them to your doorstep. To find out if your drug is one of the drugs required to be obtained through CVS Specialty, please review the formulary for your prescription plan type.
Note: MVP Medicaid Members may use CVS Specialty to obtain high-cost specialty drugs by mail. If you would prefer to obtain your specialty drugs at a local retail pharmacy, please call the pharmacy information number on the back of your ID card to get a listing of pharmacies in the MVP specialty network. Please note that prior authorization must be obtained, if required, prior to filling the specialty prescription at a network retail pharmacy or CVS Specialty.