Medication Coverage & Prior Authorization

  • New York State Medicaid Managed Care and Family Health Plus Pharmacy Benefit Information Website
    Provides easy access for members and providers looking for information on the drugs and supplies covered by different Medicaid and Family Health Plus health care plans.
  • NYS Department of Health Medicaid Pharmacy Program: ([email protected]).
  • Pharmacy Choice: NYS Law A05502B prohibits health companies from mandating mail order pharmacy. If the consumer does not have a clear option, a complaint can be filed through Attorney General’s Health Care Consumer’s Help Line 1-800-342-3736.
  • Specialty Pharmacies in NYC area
    Help with ordering  medications, prior authorization, counseling patients about use, and providing treatment adherence support.
  • CoverMyMeds
    Service that helps physicians and pharmacists complete Prior Authorization and other insurance coverage determination forms for any drug and almost all drug plans.

Assistance with Medication Cost

Pharmaceutical Company Patient Assistance Programs

Private Patient Assistance Programs

Partnership for Prescription Assistance Programs

Brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients without prescription drug coverage get free or low-cost medicines through the public or private program that’s right for them.

Medications Covered:
Hep B: Hepsera (Adefovir), Baraclude (Entecavir), Epivir HBV (Lamivudine), Tyzeka (Telbivudine),Viread (Tenofovir), Intron A (conventional interferon), Pegasys (pegylated interferon)

Hep C: Olysio (simeprevir), Sovaldi (Sofosbuvir), Victrelis (Boceprivir), Incivek (Telaprevir), Infergen (Interferon alfacon-1), Intron A (conventional interferon), Pegasys (pegylated interferon), Pegintron (peginterferon alfa-2b)

Patient Access Network (PAN)

Independent non-profit organization that provides assistance to under-insured patients for their out-of-pocket expenses for life-saving medications. Has Hep B & Hep C assistance! You can view and distribute this brochure about PAN services for Hep B & C patients.

Medications covered:
Hep B: Hepsera (Adefovir), Baraclude (Entecavir), Epivir HBV (Lamivudine), Tyzeka (Telbivudine), Viread (Tenofovir), Intron A (conventional interferon), Pegasys (pegylated interferon)

Hep C: Olysio (simeprevir), Sovaldi (Sofosbuvir), Victrelis (Boceprivir), Incivek (Telaprevir), Infergen (Interferon alfacon-1), Intron A (conventional interferon), Pegasys (pegylated interferon), Pegintron (peginterferon alfa-2b)

NeedyMeds

Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care.

Medications covered:
Hep B: Hepsera (Adefovir), Baraclude (Entecavir), Epivir HBV (Lamivudine), Tyzeka (Telbivudine), Viread (Tenofovir), Intron A (conventional interferon), Pegasys (pegylated interferon)

Hep C: Olysio (simeprevir), Sovaldi (Sofosbuvir), Victrelis (Boceprivir), Incivek (Telaprevir), Infergen (Interferon alfacon-1), Intron A (conventional interferon), Pegasys (pegylated interferon), Pegintron (peginterferon alfa-2b)

NYCRx

Non-profit organization working to increase access to affordable medications for medically underserved communities. Free Discount Prescription Card and list of partnering health centers with drug discount programs for their patients.

Chronic Disease Fund

Non-profit charitable organization that helps people with chronic disease, cancer and other life-altering conditions obtain the life-savings medications they need. Disease states may open and close throughout the year as funds are diminished or become available.

Medications covered:
Hep B: Intron A (conventional interferon), Pegasys (pegylated interferon)

Hep C: Intron A (conventional interferon), Pegasys (pegylated interferon), Pegintron (peginterferon alfa-2b)

RxAssist

Comprehensive database of patient assistance programs, as well as news and practical tools.

Medications covered:
Hep B: Hepsera (Adefovir), Baraclude (Entecavir), Epivir HBV (Lamivudine), Tyzeka (Telbivudine), Viread (Tenofovir), Intron A (conventional interferon), Pegasys (pegylated interferon)

Hep C: Olysio (simeprevir), Sovaldi (Sofosbuvir), Victrelis (Boceprivir), Incivek (Telaprevir), Infergen (Interferon alfacon-1), Intron A (conventional interferon), Pegasys (pegylated interferon), Pegintron (peginterferon alfa-2b)

Prescription Assistance 360

Patient Assistance Program: Income Caps

  • Sovaldi (gilead): The program is open to those with a maximum household income of $100,000 for up to a family of 3, and 500% FPL for families with 4 or more members.
  • Olysio (Jannsen): To qualify, the household income must be under 500% FPL.
  • Procrit: Jannsen’s program covers people with incomes up to 400% of FPL.
  • Pegintron and Victrelis (Merck and Co.): The ACT program covers people who fall within 500% FPL.
  • Incivek (Vertex Pharm): People who qualify must have a household income less than $100,000 per year.

For additional information about these programs click here

  • Pegasys: For a family size of 1-2 the income limit is $32,490-$43,710.

For additional information about this program click here

***Pharmacy Choice: NYS Law A05502B prohibits health companies from mandating mail order pharmacy. If the consumer does not have a clear option, a complaint can be filed through Attorney General’s Health Care Consumer’s Help Line 1-800-342-3736.