Pay BillDrugs Covered
Independent Health Drug Formularies are lists of drugs that are covered under your plan. Formulary drugs are medications recommended by the Independent Health Pharmacy & Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities and costs.
Independent Health's Drug Formulary I
The following information applies to plans offered through large group. Check your summary of benefits to ensure this formulary (Drug Formulary I) is associated with the plan offered to you by your employer prior to using your prescription drug benefit.
View the 2024 Independent Health Drug Formulary I
View the 2025 Independent Health Drug Formulary I
Independent Health's Drug Formulary II
The following information applies to plans offered through the NY State of Health: The Official Health Plan Marketplace – for individuals through the Individual Marketplace. This information also applies to Independent Health plans offered to individuals directly, not through the marketplace. Check your summary of benefits to ensure this formulary (Drug Formulary II) is associated with your plan prior to using your prescription drug benefit.
View the 2024 Independent Health Drug Formulary II
View the 2025 Independent Health Drug Formulary II
Independent Health's Drug Formulary III
The following information applies to small group plans available directly from Independent Health. Check your summary of benefits to ensure this formulary (Drug Formulary III) is associated with your plan prior to using your prescription drug benefit.
View the 2024 Independent Health Drug Formulary III
View the 2025 Independent Health Drug Formulary III
Independent Health’s FEHB Drug Formulary
The following information applies to plans offered through Federal Employees Health Benefits (FEHB). Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit.
View the 2024 FEHB Drug Formulary
View the 2025 FEHB Drug Formulary
Formulary (Drug List) Changes
This list contains both upcoming and past changes to Independent Health's employer and individual/family formularies.
Independent Health’s Child Health Plus Formulary
The following information applies to Independent Health’s New York State Sponsored Child Health Plus plan. Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit.
View the 2024 Child Health Plus Drug Formulary
View the 2025 Child Health Plus Drug Formulary
Essential Plan Formulary
The following information applies to plans offered through the Essential Plan. Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit.
View the 2024 Essential Plan Formulary
View the 2025 Essential Plan Formulary
MediSource and MediSource Connect prescriptions are covered through NYRx, the Medicaid Pharmacy Program. Information about NYRx, the Medicaid Pharmacy Program, can be found here.
Guidance for Practitioners Billing Medications
Per New York State Education (NYSED) Law, Article 137 §6807, practitioners who are authorized to prescribe may dispense certain classes of medications to patients directly out of their office. When dispensing, practitioners must maintain records for the dispensing and follow all state and federal regulations and Independent Health policies.
To bill medications dispensed to Independent Health members, use the following HCPCS code and the corresponding NDC for the product dispensed:
J8999 – Rx Drug Oral Chemotherapy
J8499 – Rx Drug Oral Non-Chemotherapy
In some cases, Independent Health requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition:
View the 2024 Step Therapy Criteria (Employer & Individual/Family)
View the 2025 Step Therapy Criteria (Employer & Individual/Family)
Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified:
View the 2024 Quantity Limits Criteria (Employer & Individual/Family)
View the 2025 Quantity Limits Criteria (Employer & Individual/Family)
Don’t See Your Drugs Covered?
Fill out our Request for Pharmacy Drug Authorization Form
Want to Get Your Meds Through the Mail?
Learn how to use our Mail Order option