The Empire Prescription Drug Program is administered through CVS Caremark. The Plan offers a three-tier copayment for generic, preferred brand name and non-preferred brand name medications. The information provided in the Drug PDF lists below is subject to change. To ensure you have the most recent information concerning the drugs covered, please contact The New York State Health Insurance Program (NYSHIP) at 1-877-769-7447 and select the prompt for CVS Caremark for specific prescription drug plan information.
Please see the links below for more information about drug coverage benefits.
Empire Plan Prescription Claim Form, CVS Caremark (pdf)
CVS Caremark Prescription Mail Order Form (pdf)
Flexible Formulary Preferred Drug List (pdf)
Drugs (including generic equivalents) that require prior authorization (pdf)
Flexible Formulary Excluded List (pdf)
Print as PDF