Health Care

Prescription Drug

Dental Plans

Prescription Drug

Each of of the NYWGF Health Plan options includes prescription drug coverage through MVP Health Care.  This valuable benefit entitles you to coverage for thousands of medications and makes filling prescriptions easy.  Simply visit any participating retail pharmacy, or take advantage of MVP's Mail Order program to save time and money.

NYWGF's EPO $30 plan includes a $10/25/40 prescription drug formulary plan.  This plan has a $2,500 annual maximum, and then covers 50% of costs after the maximum.  This means that you only pay a low copayment at the pharmacy prior to meeting your maximum.  The maximum accumulates based on MVP's cost toward your prescription.  For instance, take the example of a brand name formulary medication that costs $100 retail, but MVP's discounted rate is $80.  You would pay a $25 copayment, and the remaining $55 ($80 MVP discounted cost - $25 copayment) would accumulate toward your $2500 out of pocket maximum.  Should you reach your out-of-pocket maximum in a given year, you would simply pay 50% of MVP's discounted rate at the pharmacy and MVP covers the remaining 50%.

NYWGF's Comprehensive EPO $40 plan includes a $10 unlimited generic prescription rider.  This means that all generic medications are covered at a $10 pharmacy copayment - with no annual maximum.  However, should you and your doctor determine that a brand name medication is right for you, you will still have access under this plan to MVP's discounted pharmacy rates.  This discount varies by medication and pharmacy, but offers members significant savings from retail costs.  You can also use the mail order program to take advantage of additional cost savings.

NYWGF's Preferred Qualified High Deductible plan $5,000, includes a 3-tier prescription drug formulary plan. After the deductible is satisfied, Tier 1 (Generic drugs) and Tier 2 (Brand drugs) require a 25% copay. Tier 3 (Non-formulary) will require a 50% copay.

What is a formulary?  A formulary is the approved list of covered medications - those proven safe and effective, in the best interest of MVP's members.  New prescription drugs are reviewed on an ongoing basis for potential addition to the approved list to ensure you have access to the latest advances in medicine.  The formulary also applies to mail order eligible prescriptions. 

MVP divides prescription drugs into three tiers to make it easier for you and your doctor to choose the most appropriate, lowest cost drug to treat your condition. 

     Tier 1:  Lowest copay choice and usually includes generic drugs
     that meet the MVP guidelines for a Tier 1 drug.
     Tier 2:  Mid-range copay choice and includes covered brand-name
     drugs that have been selected as Tier 2 drugs because of their
     overall value.
     Tier 3:  Highest-copay choice and includes all other covered
     prescription drugs - generic and brand.  It also includes those that
     are not on the prescription drug list and those that are being reviewed.

For an updated list of covered medications, click here to download MVP's current formulary.