• Pharmacy

  • Formulary (Drug) Information

    Covered Drug List

    Also called a Comprehensive Formulary, it contains information about Medications that we cover listed by name and/or condition

    Formulary Search

    To see if your medication is on the Covered Drug List

    Prior Authorization Criteria

    Guidelines for getting a medication covered

    Step Therapy Criteria

    List of alternative medications to try first

    Negative Formulary Changes

    Medications removed from the Comprehensive Formulary

    Drugs Covered by Medicaid for Dual Eligibles

    A list of Medications covered for our Ultimate and Solution members only

  • Medicare Part D Program(s) Information

    Transition Program and Policy

    Information regarding a temporary fill of non-covered medication to prevent a disruption of therapy

    Medication Therapy Management

    Information for those on Multiple Medications and who meet specific criteria. La información también está disponible en español

  • Medicare Pharmacy Directory

    Pharmacy Directory

    For Pharmacies located in NYC, Rockland, Westchester, Orange, Suffolk, and Nassau Counties

    Pharmacy Locator

    Search for a specific type of Pharmacy in your area or when out town

  • Tools and Resources

    Low Income Subsidy (LIS/"Extra Help") Table

    Information regarding what you will pay for your plan premium if you receive “Extra Help”

    Drug Information

    Use these tools to get drug facts for prescriptions, non-prescription medications, vitamins and supplements. Plus, check drug interactions, identify pills and create your personal medicine list

    Information for Members on Blood Thinners

    Safety Information for those on a prescription Blood Thinner

    Locations for Medication Disposal

    Department of Health locations for the safe disposal of any unwanted medications

    Fraud, Waste and Abuse Information and Reporting

    Please refer to tips to prevent fraud, how to spot fraud, and reporting fraud for more information.There you will also find information regarding potential areas where Medicare Fraud may occur. Help keep costs low by being aware of the different types of Medicare Fraud.

  • Forms

    For Mail Order Medications through CVS/Caremark Pharmacy
    Medicare Pharmacy Claim Form

    Please use this form if you have paid an out of pocket cost for a Covered Part D Prescription Medication only.

    Coverage Determinations and Exceptions

    Information on how Members and Providers can request a medication to be covered (Also sometimes referred to as a Prior Authorization)
    Coverage of a Medicare Medication: PDF | Online

    You can also write or call for Coverage Determinations (Prior Authorizations) or Exceptions::
    CVS Caremark Part D Appeals and Exceptions
    P.O. Box 52000, MC109
    Phoenix, AZ 85072-2000
    Phone: 866.362.4002
    Fax: 855.633.7673
    TTY: 711

    When Affinity receives a request for payment or to provide a Part D drug to a Member, it must determine whether the requested prescription drug is necessary and appropriate and what the Members’ share of the cost is for the drug. These actions by Affinity are known as “coverage determinations”.

    Coverage determinations include exception requests. You have the right to ask us for an “exception” if you believe you need a drug that is not on our list of covered drugs (formulary) or believe you should get a drug at a lower copayment. If you request an exception, your doctor must provide a statement to support your request. Once we receive a statement from your doctor, we must make a coverage determination. We must make coverage determinations and notify the affected Member within 72 hours of receiving the request or sooner if their health condition requires more immediate action. If immediate action is necessary, you or your physician can request that we review your situation in 24 hours.

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  • Affinity Health Plan is an HMO and HMO-SNP Plan with a Medicare contract and a contract with the New York State Medicaid Managed Care Program. Enrollment in Affinity Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance and restrictions may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, Part D co-pays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Affinity Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 877.234.4499 (TTY: 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 877.234.4499 (TTY: 711) 。