A physician uses a laptop and has a hand poised to take notes in a notebook

Find a
pharmacy

Finding a pharmacy that is covered by MetroPlusHealth is easy. There are over 500 pharmacies in New York City that take MetroPlusHealth, including:

cvs-pharmacy-logo
rite-aid-logo
DuaneReade_WalgreensFamily-Logo-DD
logo__independently-owned-comunity-pharmacies

Pharmacies covered by MetroPlusHealth are available in all five boroughs, including some 24-hour drugstores. We also pay for delivery-based services like Capsule and mail order medication through PillPack or CVS Pharmacy.

Find a Pharmacy

To search providers based on your location, please explore our network directory:

A woman sitting at a table in front of a window is drinking coffee and looking at her phone on the table

Find a Pharmacy

Find pharmacies on your plan or nearby.

Pharmacy Benefits & Formulary  

What medications are covered?

Want to know in advance what medications MetroPlusHealth will help pay for? Look it up in your plan formulary. A formulary is a list of prescription drugs and therapies that an insurer has approved for its members.

We will generally cover anything listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MetroPlusHealth network pharmacy, and other plan rules are followed. Your plan benefits page can explain in more detail. Of course, if you still have questions, you can always call or contact us.

 

FormulariesDocuments (PDF)
Medicaid
Child Health Plus
Partnership In Care (SNP)
MetroPlusHealth Enhanced (HARP)

effective date: October 2022

As a requirement by the NY Department of Health, MetroPlus Health Plan, in alignment with NYS Medicaid Fee-For-Service, provides coverage for select over the counter (OTC) medications or products when a prescription is presented at a NYS enrolled participating network pharmacy. Select analgesics, allergy, cough and cold preparations, digestive products, insulin, topical products, and vitamins with or without minerals may be eligible for coverage. Not all formulations, sizes or products are covered in every category. If the product National Drug Code (NDC) is not found on the NYS Medicaid FFS formulary file, then it is not eligible for coverage. The link to the Medicaid FFS list of reimbursable drugs is available here: https://www.emedny.org/info/formfile.aspx.

Medicaid, SNP, HARP Non-enrolled Provider Override Guidance

effective date: October 2022

Marketplace Plans (Individual)
Marketplace Plans (SHOP)
Essential Plan

effective date: December 2022

MetroPlus Gold

effective date: December 2022 

MetroPlus GoldCare I & II

effective date: December 2022

2022
Medicare
UltraCare

effective date: December 2022

2023
Medicare
UltraCare

effective date: January 2023

The links open documents in PDF, Word or Excel format. If you have problems viewing any of the documents contact your Provider Services Representative. Download Acrobat Reader, a PDF viewer.

 

MetroPlusHealth and Medly Partnership

Want free delivery of your medications? Looking to get your medications sent to you pre-packaged? Want a pharmacy that you can text? MetroPlusHealth has partnered with Medly Pharmacy to offer these services and more! To learn more, click here or call Medly at (929) 454-5090.

MEDICATION ASSISTED TREATMENT (MAT) FORMULARY CHANGE NOTIFICATION FOR METROPLUSHEALTH MEDICAID MANAGED CARE, PARTNERSHIP IN CARE (PIC) HIV-SNP, AND ENHANCED (HARP) PLAN MEMBERS

Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder. Prescriptions written outside of accepted guidelines may be subject to prior authorization. For more information and a list of medications, please visit here.

Prescriptions for a brand name multi-source drug will be filled with a generic equivalent, as required by New York State Social Services and Education Law, unless the Prescriber indicates “Dispense as Written (DAW)”, and “Brand Medically Necessary” on the prescription.

Provider Tools

  • To view our Pharmacy Policies (for Providers, including Pharmacies), click here.
Pedestrians crossing a busy intersection in a crosswalk

Find Your Plan

Explore MetroPlusCoverage that’s right for you. You can sign-up digitally, too.

last updated: October 31, 2022

Ready to Join Us?

Talk to us about questions or concerns

Monday–Saturday | 8 am–8 pm (ET)

Already A Member?

Log into the Member Portal

See Plan information, Health Rewards, and Messages

Speak To Someone In Your Community

Find someone in your neighborhood and in your language