Pharmacy Information for Providers

2024 MVP Formularies

The list of drugs covered by the Member’s plan, referred to as the Formulary, could change throughout the year. For select Commercial and Marketplace Members (including Child Health Plus and Essential Plan Members), changes made to remove drugs from the Formulary or to add new clinical requirements will take effect on their Pharmacy “Plan Year” start date. To find their Pharmacy “Plan Year” start date, Members can sign in to their MVP Member Online Account and select My Plan, then My Benefits.

• 2024 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. 
• 2024 MVP Marketplace Formulary (PDF)  — Applies to individuals who purchase their health plan on their own from NY State of Health, The Official Health Plan Marketplace—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, and to students enrolled in a student health plan through their college or university.
• 2024 MVP Self-Funded Formulary (PDF)
• 2024 MVP Medicare Part D Individual Plan Formulary (PDF) — Applies to individuals who purchase their Medicare Advantage plan coverage directly from MVP.
• 2024 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.
• 2024 UVM Health Advantage Medicare Part D Comprehensive Formulary (PDF) — Applies to individuals who purchase their Medicare Advantage plan through UVM Health Advantage.

2023 MVP Formularies 

The following are formularies that are part of our 2023 plans:

• 2023 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. 
• 2023 MVP Marketplace Formulary (PDF)  — Applies to individuals who purchase their health plan on their own from NY State of Health, The Official Health Plan Marketplace—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, and to students enrolled in a student health plan through their college or university.
• 2023 Formulary Updates for Commercial and Marketplace Formularies (PDF)
• 2023 MVP Medicare Part D Individual Plan Formulary (PDF) — Applies to individuals who purchase their Medicare Advantage plan coverage directly from MVP. 
• 2023 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. 
• 2023 UVM Health Advantage Medicare Part D Comprehensive Formulary (PDF) — Applies to individuals who purchase their Medicare Advantage plan through UVM Health Advantage.

Commercial and Marketplace Information 

• MVP Pharmacy Billing Guidelines for COVID-19 Testing - Effective TBD (PDF)

• MVP Pharmacy Billing Guidelines for COVID-19 Vaccines (PDF)

Medicare and Medicaid Information 

For Medicare information, including common Part D forms, online billing, high risk medications, and more visit our Medicare Pharmacy Information for Providers page 

See below for common Medicaid resources: 

• DOH Required Policy and Billing Guidelines
• Practitioner Dispensing Billing Guidance (PDF)

Beginning April 1, 2023, all Medicaid members enrolled in MVP Medicaid Managed Care will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Information about the transition of the pharmacy benefit from MVP Medicaid Managed Care to NYRx, the Medicaid Pharmacy Program, can be found on health.ny.gov.

General information about NYRx, the Medicaid Pharmacy Program, can be found on health.ny.gov along with information for Members and Providers.

Pharmacy Prior Authorization Forms 

Below you will find a selection of our most common Pharmacy forms. You can find the full range of Provider forms in our Provider Forms Library. For common Medicare pharmacy forms, visit our Medicare Pharmacy Information for Providers page. 

• NYS Medicaid Prior Authorization Request Form for Prescriptions (PDF)
• Prior Authorization Request Form for Medication (PDF)
• NYS Contraceptive Prior Authorization Request Form (PDF)

MVP Mail Order Pharmacy Program 

MVP Members who have prescription drug coverage may be able to order maintenance drugs—drugs taken on a regular basis—from CVS Caremark Mail Service Pharmacy, MVP’s mail service pharmacy vendor. Up to a 90-day supply of medication can be ordered through this program. Once a member's prescription is on file with CVS Caremark Mail Service Pharmacy, Members can order refills by mail, phone, or online and have their medication delivered to their door.  

Note: This service is not available to all MVP Members. To find out if a medication is available from CVS Caremark Mail Service Pharmacy, choose the appropriate formulary; if a drug or drug class has an * next to it, that drug or all drugs in that class are available through mail service.  

An MVP member who is taking a maintenance drug may ask you to write two prescriptions, one for up to a 30-day supply to be filled at a local pharmacy, and one for up to a 90-day supply to be filled through CVS Caremark Mail Service Pharmacy.  

Members interested in finding out more about the mail service program can contact MVP’s Customer Care Center at the phone number listed on the back of their Member ID card.