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Pharmacy and prescription drugs

We offer a wide range of prescription and over-the-counter (OTC) drugs, home delivery and more. We work with Express Scripts (ESI) to provide these benefits.

To find a pharmacy near you, use the ESI pharmacy locator tool.

Find a pharmacy

Copays

Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.

There may be copays for your prescriptions. Check your member handbook to see if your plan has copays.

Your copay for prescriptions is $3 for brand-name drugs and $1 for generic drugs. Members under age 21 and pregnant women do not have copays.

You can also get OTC medicines with a prescription from your doctor. Your copay is $0.50 for OTC medicines.

There are no copays for covered drugs.

Your copay for prescriptions is $3 for brand-name drugs and $1 for generic drugs. Members under age 21 and pregnant women do not have copays.

Managed Long-Term Care (MLTC) members

Your pharmacy benefits are not covered through Empire. You either get these services through Medicare or through fee-for-service Medicaid.

Learn more about MLTC

Find out if your prescription is covered

Preferred Drug List (PDL)

Empire has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL).

Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before they can write a prescription for the drug. Go to the preapprovals section, below, for more information.

The PDL can change at any time. Please check back for updates.


Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists both drugs found on the PDL and others not listed on the PDL. Use our searchable formulary to search for drugs by:

  • Typing the name of the drug in the search box
  • Using the A-Z list to search by the first letter of the drug name
  • Clicking the therapeutic class of the drug

Essential Plan members

Essential Plan formulary

Medicaid members

Medicaid formulary

CHPlus members

CHPlus formulary

HARP members

HARP formulary
Don’t see it listed?

If you need to take a drug not listed in the formulary, you may request an exception at submitmyexceptionreq@empireblue.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug.

Preapprovals

Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must get preapproval before you can fill your prescription. Your doctor can get this by calling our Pharmacy department.

Drugs that require preapproval include those that:

  • Have high side-effect potential
  • Should be prescribed only for specific usage
  • Have high misuse or abuse potential
  • May cost more than other preferred drugs

The preapproval process helps us make sure you’re taking medicines safely and correctly.

Other times you may need preapproval are:

  • When requesting a higher dosage than recommended
  • When requesting a brand-name drug that already has an FDA-approved generic version
  • When the drug is part of a step therapy treatment plan. Step therapy means trying less expensive options before "stepping up" to drugs that cost more.
 
 

Express Scripts (ESI) forms

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Need to talk with a nurse?

Whether it’s 3 a.m. or a Sunday afternoon, health issues happen at the most inconvenient times. Our 24/7 NurseLine gives you fast, free medical advice anytime, day or night. Call 1-800-300-8181 (TTY 711).