About the Senior Whole Health of New York Formulary
We have a formulary that lists all of the drugs that we cover. Senior Whole Health of New York generally covers all the drugs listed in our formulary as long as the drug is medically necessary. Prescriptions are filled at a network pharmacy or through our network mail order pharmacy service. For certain prescription drugs we have additional requirements for coverage or limits on our coverage.
The drugs on the formulary are selected by our plan with the help of a team of health care providers. We select the prescription therapies believed to be a necessary part of a quality treatment program, and both brand name drugs and generic drugs are included on the formulary.
Download the Formulary
Download the Senior Whole Health of New York NHC (HMO SNP) 2020 Comprehensive Formulary (PDF).
Using the Senior Whole Health of New York Formulary
There are two ways to find a drug within the formulary:
The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Medications. Look for the category name in the list and then look under the category name for the drug.
You can also look for the drug in the index at the back of the formulary. The index provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed in the index. Look in the index and find the drug. Next to the drug, you will see the page number where you can find coverage information. Turn to the page listed in the index and find the name of the drug in the first column of the list.
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Changes in the Senior Whole Health of New York Formulary
The Senior Whole Health of New York Formulary is updated periodically throughout the year.
Below is a list of changes to the Senior Whole Health of New York NHC (HMO SNP) Formulary,
Download the Medicare Part D Formulary Change Chart (PDF).
Prior Authorization Criteria
Senior Whole Health of New York requires members to get prior authorization for certain drugs. Without approval, Senior Whole Health of New York may not cover the drug. The following document provides a list of drugs that require Prior Authorization.
Download the Senior Whole Health of New York 2020 Prior Authorization Criteria (PDF).
Prior Authorization Forms
Please call the Senior Whole Health of New York Pharmacy Department directly at 617-252-6366 to have a form individualized to the patient faxed to you.
Drug Coverage Determination Form (PDF) in English for Senior Whole Health of New York NHC (HMO SNP) Plan
Quantity Level Limits
For certain drugs, Senior Whole Health limits the amount of the drug that you can have by limiting how much of a drug you can get each time you fill your prescription. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day.
In some cases, Senior Whole Health of New York requires members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the member's medical condition, Senior Whole Health Plus of New York may not cover Drug B unless the member tries Drug A first. If Drug A does not work for the member, Senior Whole Health of New York will then cover Drug B. The following document provides a list of drugs that require Step Therapy.
Download the Senior Whole Health of New York NHC 2020 Step Therapy Algorithms (PDF).
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Last Updated 1/01/2020