Pharmacy Information for Providers

Commercial and Marketplace Information

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

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

Pfizer offers cost sharing programs for Paxlovid, a prescription medication used to treat COVID-19. This is available for commercially insured and Medicare members. If you have commercial insurance, see if you qualify here: Co-Pay Programs | PAXLOVID™ (nirmatrelvir tablets; ritonavir tablets).

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.

Pfizer offers cost sharing programs for Paxlovid, a prescription medication used to treat COVID-19. This is available for commercially insured and Medicare members. If you have Medicare, see if you qualify here: PAXCESS™ | PAXLOVID™ (nirmatrelvir tablets; ritonavir tablets).

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.