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Find a
pharmacy

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

Pharmacies covered by MetroPlusHealth are available in all five boroughs, including some 24-hour drugstores. We may 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:

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Find a Pharmacy

Find pharmacies on your plan or nearby.

Find a Pharmacy

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.

Formularies	Documents (PDF)
Child Health Plus	Formulary Quick Reference Guide effective date: April 1, 2023
Medicaid Partnership In Care (SNP) MetroPlusHealth Enhanced (HARP)	Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. To access NYRx, the Medicaid Pharmacy Program’s formulary click here.
Medicaid, SNP, HARP Non-enrolled Provider Override Guidance	Pharmacy Claim Rejections effective date: October 2022
Marketplace Plans (Individual) Essential Plan	Formulary STEP Criteria effective date: May 2023
MetroPlus Gold	Formulary STEP Criteria effective date: May 2023
MetroPlus GoldCare I & II	Formulary STEP Criteria effective date: May 2023
Medicare UltraCare	Comprehensive Formulary STEP Criteria Prior Authorization Part B Diabetes Monitoring Device and Supply Policy effective date: May 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.

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.