Whether you need prescription drugs or over-the-counter (OTC) medication, Healthfirst makes it easy to get the medicine you need.
Getting Your Prescriptions
Staying on track with your medications can be hard. Healthfirst can help make it easier.
Whichever pharmacy you choose, ask if they can send you refill reminders. That way you’ll know when it’s time to pick up your next refill and always have enough medication available. It’s very important to continue to take your medications as directed by your doctor.
Sometimes it could be challenging to refill and pick up your medications every month. Ninety-day prescriptions may be a good option for you. Instead of picking up your medication every month, you can pick it up every three months. That’s just four (4) times a year instead of 12. Ask your doctor about a 90-day prescription for your medications.
Healthfirst Pharmacy Team [exclusively for Healthfirst Medicare Advantage plan members]
If you’re a Healthfirst Medicare Advantage plan member, we can help you manage your medications to stay on track with your refills. We’ll send you reminders and can also help with any challenges you may have with getting your prescriptions.
Our Healthfirst pharmacy team is here to help. Call 1-844-347-2955.
Medication Therapy Management
The Healthfirst Medication Therapy Program is a free service for eligible Healthfirst members. A licensed pharmacist thoroughly reviews all your medications, will answer any questions you have about your medications, and can work with your doctor on any adjustments you may need with your medications. To see if you’re eligible for the program, click below:
Sometimes the daily stress of managing life can make it hard to manage your health.
If you need help with this, we can help connect you to community resources.
Here’s how to find help with essential services in your area:
1) Sign in to the Healthfirst NY Mobile App
Tap on “Resources” (near the bottom of the screen) to get started.
2) Search for services near you
Get assistance with food, housing, education, employment, childcare, and many other challenges.
Don’t have the app yet?
Click below. Available for iOS and Android.
If your Healthfirst plan includes an over-the-counter (OTC) allowance, we’ll send you a pre-funded Healthfirst OTC card. For information on how to activate your OTC card, how your allowance works, what you can buy with it, and more, click below:
As a reminder, unlike prescription medications, most OTC drugs don’t require a doctor’s prescription and can be bought at a regular store, not just a pharmacy. Also, since you don’t need a prescription, remember that these items aren’t covered by your plan’s prescription drug benefit, but you may be able to get them with your OTC allowance.
You can go to any pharmacy in our large network to get your prescription medication. Find one that's convenient for you here.
You may be able to get your prescription delivered by mail. Find more information here.
No. You can switch to any pharmacy in our network.
Yes. Most pharmacies can work directly with your doctor and other pharmacies to switch your prescriptions.
No. You can go to any pharmacy in the Healthfirst network.
CVS Caremark works with health plans like Healthfirst to manage your pharmacy benefits. You can get your prescriptions filled at any pharmacy in the Healthfirst network.
Prescription Coverage Questions
You can check your Healthfirst plan’s formulary. A formulary is a list of prescription medications that are covered and approved by your plan. We only pay for the medications (brand or generic) that are on this list, unless your doctor contacts us to get an exception and receives approval. You can check to see if your medications are on your plan’s formulary here.
For some prescription medications, your doctor may need to get prior authorization from us before it’s approved for you to pick up at your pharmacy. If your doctor doesn’t get approval from us first, then we may not cover the medication, and the prescription may not be available when you go to pick it up. To avoid this situation, your doctor should understand which medications need prior authorization and reach out to Healthfirst for approval before giving you a prescription for that medication. If you have any concerns about medications that may need prior authorization, talk to your doctor.
There are various factors that affect your out-of-pocket costs. If you have questions about your specific costs or coverage, please contact us for assistance.
Generic drugs are approved by the FDA to be just as safe and effective as brand-name drugs. They both have the same active ingredients, but generic drugs usually cost a lot less. This means you can save money on your prescriptions and still get the same benefits as you would from brand-name medication. Talk to your doctor about whether generic medications are right for you.
Depending on your plan, you may have an annual drug deductible. If you do, then at first you would pay the full cost for your prescription medication until you have reached your deductible amount. Then we’ll pay for either the full cost of the medication or a portion of it, depending on your plan.
Some Medicare Advantage plans have a Coverage Gap, also called a donut hole, for prescription drugs. Not all Medicare members would be affected by the Coverage Gap. It only begins after you and your plan have spent a predetermined amount on your prescription drugs. If you do reach the Coverage Gap, your plan would cover less of the cost for your drugs. This means your out-of-pocket cost would be higher while you’re in the gap. The Coverage Gap is one of four coverage stages created by the Centers for Medicare & Medicaid Services (CMS) for Part D Prescription Drug Coverage.
You can find various forms, documents, and resources, listed by your plan.
Get personalized information about your Healthfirst coverage by logging in to your secure account.
We’re here to help you get the support you need. If you’d like more help, please contact us.
Coverage Decisions, Appeals, and Complaints for Medicare Members
For Medicare Advantage members, you can find information and forms related to coverage determinations, appeals, and complaints here.
Coverage is provided by Healthfirst Health Plan, Inc. Plans contain exclusions and limitations.
Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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