Quality Health Plans’ Pharmacy Formulary is a continuously reviewed list of prescription medications that best represents the current clinical judgment of our providers and other experts in the diagnosis and treatment of different diseases.  There are three types of the formulary on this web site.  First, is the Abridged Formulary.  You may print out this document  and present it to your physician to ensure that a formulary product is prescribed when possible.  Keep this list of medications as a quick reference for your prescription medication coverage benefits.  Second, is the Comprehensive Formulary which covers all drugs in the formulary.  Third, is a searchable full version of the formulary which you may use to determine if a medication is covered and, if so, what  the co-pay is for that medication.

Check out our easy-to-use search engine that allows you to search our extensive formularies.  Not only find out if we cover a particular drug, but you may determine what, if any, co-pay there is for that drug.  The search engines even allow you to find less expensive alternative for that drug.  We know you will find this feature useful and enlightening.  Click on the Drug Search header above to search our formulary.

Prior Authorization Forms
Prior Authorization Request for Quantity Override
Prior Authorization for Tiering Exception
General Request for Prior Authorization
Prior Authorization Request for Non-Formulary Medications

This is the handy version of our formulary that is a manageable size: just right for printing out and taking to your doctor.  There are 2 versions of the Florida abridged formulary: Version 1 for Advantage  and Value One Florida.  Version 2 for Advantage Silver, Advantage Silver East, Advantage Silver North & Central, Advantage Silver South and Advantage Health Florida.   Finally,  There are 3 versions of the New York abridged formulary. NY Version 1 for Advantage Silver NY, Advantage Health NY, Advantage Platinum Suffolk and Advantage Health Suffolk.   NY Version 2 for  Advantage Platinum NY.   NY Version 3 for Advantage Value One NY.  Click the appropriate icon to view, print or save your abridged formulary.

FL Version 1
FL Version 2
NY Version 1
NY Version 2
NY Version 3
Step Therapy Criteria
Prior Authorization Criteria

There are 2 versions of the Florida comprehensive formulary: Version 1 for Advantage  and Value One Florida.  Version 2 for Advantage Silver, Advantage Silver East, Advantage Silver North & Central, Advantage Silver South and Advantage Health Florida.   Finally,  There are 2 versions of the New York comprehensive formulary. NY Version 1 for Advantage Silver NY, Advantage Health NY, Advantage Platinum Suffolk, Advantage Health Suffolk.   NY Version 2 for Advantage Platinum NY.   NY Version 3 for Advantage Value One NY. Click the appropriate icon to view, print or save your abridged formulary.

FL Version 1
FL Version 2
NY Version 1
NY Version 2
NY Version 3