Employers – Prescription Benefits

New York Individual and Small Group Plans

For individual health plans purchased from NY State of Health, The Official Health Plan Marketplace, or directly from MVP Health Care. Also applies to NY small group (100 employees or less) plans.

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New York Large Group Plans

For NY large group (101 employees or more) plans.

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Vermont Individual and Small Group Plans

For Individual and small group plans sold through Vermont Health Connect (VHC)

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Vermont Large Group Plans 

For VT large group (101 employees or more) plans

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Preventive Drug List

List of covered preventive drugs as of July 2023; applies to New York and Vermont.

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No-Cost Drugs for Preventive Care

List of current covered preventive drugs; applies to New York and Vermont.

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Vermont Value Based Insurance Drug (VBID) List

List of affordable maintenance medications, with a small co-pay of $1 or $3, available to VT Plus Plan members with chronic conditions.

Download the list.

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 into Gia® and select My Plan, then My Benefits.

• 2025 MVP Commercial/Child Health Plus Formulary (PDF)—Applies to large groups; plans offered by employers with greater than 100 employees, and MVP Child Health Plus.
• 2025 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.
• 2025 MVP Self-Funded Formulary (PDF)—Applies to Administrative Services Only plans.

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 into Gia® 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, and MVP Child Health Plus.
• 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)—Applies to Administrative Services Only plans.

Members can sign into Gia® to manage prescriptions, check drug cost and coverage, view or refill mail order prescriptions, get tips on how to save money, and more. MVP members can also sign in to take advantage of CVS Caremark’s full suite of helpful tools.

The CVS Caremark Customer Care team can help explain prescription coverage to members 24 hours a day, 7 days a week.

CVS Caremark Customer Care Phone Numbers

• Commercial/Select Care: 1-866-284-7134
• Exchange: 1-800-378-9295
• Medicaid: 1-866-832-8077
• Medicare: 1-866-494-8829 (TTY: 711)
• TTY: 1-800-231-4403
  
  

Find information on drug recalls and updates on our Pharmacy News page.

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