Hudson Health Plan Drug Information

On this page you will find important information about your pharmacy benefits,
as well as useful drug information, formularies, and frequently asked questions.

Pharmacy Benefits

Effective October 1, 2011, Medicaid and Family Health Plus members will receive pharmacy benefits through Hudson Health Plan. If you are a member, you should have received a new Hudson Health Plan ID Card that lists a contact number for MaxorPlus—this is the Pharmacy Benefit Management vendor we use to provide your pharmacy benefit.

Hudson Health Plan members must fill prescriptions at a pharmacy that is in MaxorPlus’ network. Click below to search for a participating pharmacy, log in to your MaxorPlus account, or register online.

                                               

If you have questions about MaxorPlus and your pharmacy benefits, please review the Frequently Asked Questions below, or contact Maxor Plus Customer Service at 1-800-687-0707. 

Formularies

A formulary is a list of covered drugs chosen by Hudson Health Plan. On a regular basis the formularies are reviewed by a team of health care providers and they include medications that we believe are important to cover for our members. Note: Brand name drugs with generic equivalents are generally not covered on the Hudson Health Plan formulary. As brand name drugs become available generically, only the generic will be considered formulary.

Please access your formulary by clicking on the one that is specific to your type of coverage (Child Health Plus, Family Health Plus, or Medicaid):

Co-Payments

A co-payment is a small percentage of a medication's cost that you sometimes pay when filling a prescription. Your co-payment may be different depending on your type of coverage (Child Health Plus, Family Health Plus, or Medicaid). Please refer to the following chart to see if you might be required to pay a co-payment:

Prior Authorizations

In some cases, a prescription for a certain medication may need prior authorization from your insurance company. If you have questions, please contact Maxor Plus Customer Service at 1-800-687-0707. The following is a list of items requiring prior authorization:

  • Any brand name drug with a generic equivalent, except the drugs covered under the Mandatory Generic Drug Program Exclusions; call MaxorPlus Customer Service at 1-800-687-0707 for additional information
  • Ampyra
  • Arcalyst
  • Claims over $2,000
  • Compounds over $100
  • Diabetic supplies if over $500
  • Dificid
  • Emend Inj
  • Enteral formulas (ingestion must be by some method other than oral)
  • Gilenya
  • Glucometers if over $500
  • Growth hormone agents for all ages
  • Injectables over $250
  • Isotretinoin (ex. Accutane)
  • Fentanyl buccal or oral products (Onsolis, Actiq, Fentora, Abstral)
  • Lidoderm prescriptions for all ages
  • Medications for Pulmonary Hypertension (Adcirca, Letiris, Revatio, etc.)
  • Nuvigil
  • Provigil
  • Recothrom
  • Regranex for diabetic ulcer treatment
  • Revlimid
  • Serostim (regardless of patient's age)
  • Some OTCs on the New York State Formulary
  • Sporanox
  • Synagis for the prevention of RSV
  • Topical immunomodulators such as Elidel or Protopic and the generics thereof
  • Topical Tretinoins for ages 40 and above
  • Vitamins deemed necessary to treat a diagnosed illness or condition (Prior authorization is not required for prenatal vitamins)
  • Vfend
  • Xyrem for the treatment of narcolepsy
  • Zyvox for the treatment of infection, specifically MRSA

Frequently Asked Questions

Who is MaxorPlus?
MaxorPlus is the Pharmacy Benefit Manager (PBM) for Hudson Health Plan. As such, MaxorPlus processes all pharmacy claims for Hudson Health Plan. For more information about MaxorPlus, please visit MaxorPlus.com.

Who do I call if I have questions about my prescription benefits?
Please call MaxorPlus Customer Care (1.800.687.0707) for questions specifically related to your pharmacy benefits, covered drugs, excluded drugs, and drug-related prior authorizations.

Who do I call if I have questions about my medical benefits?
Please call Hudson Health Plan Customer Care (1.800.339.4557) for any medical benefits questions, ID cards, or eligibility.

Where can I fill my prescriptions?
Please use the Pharmacy Lookup tool to locate a participating pharmacy in your service area, including pharmacies open 24 hours a day.

How do I use my pharmacy benefit?
Your prescription drug benefit can be used nationwide to obtain prescriptions from any participating pharmacy listed in your pharmacy network. You should find a MaxorPlus participating pharmacy within most cities across the United States. Please call 1.800.687.0707 for help in locating one near you or search for one online using our Pharmacy Lookup tool. Your Hudson Health Plan ID card should replace any previous ID cards that you have received and be presented to any participating MaxorPlus retail pharmacy. Present your ID card to the pharmacist and confirm that the pharmacy has the most current coverage information on file, as provided on your card.

What if I use a pharmacy that is not in the MaxorPlus pharmacy network?
MaxorPlus has an extensive network of pharmacies nationwide; however, some pharmacies may not be in the network. Hudson Health Plan requires members to use a MaxorPlus network pharmacy. Prescriptions purchased at "non-participating pharmacies" are covered only in emergency situations. In this case, you will need to pay 100% of the prescription cost, obtain a receipt, and submit a paper claim form to MaxorPlus for reimbursement. You will be reimbursed the contracted amount that would be paid to the pharmacy. Paper claim forms may be obtained online at MaxorPlus.com or by calling MaxorPlus at 1.800.687.0707.

How often can I obtain refills?
Prescription drugs dispensed at the MaxorPlus participating network pharmacies are limited to a 30-day supply. If your health care professional has authorized refills, you may refill your prescription once 75% of the prescription has been used. For example, for a 30-day supply prescription, you may refill the prescription when you have 7 days of medication remaining. The only exception to this is any medication that contains a narcotic. Narcotics cannot be filled until 90% of the prescription has been used. For example, for a 30-day supply prescription, you may refill the prescription when you have 3 days of medication remaining.

How do I know the copay of a drug or if a Prior Authorization applies to the drug?
Creating a profile with MaxorPlus allows you to view the copay of drugs, see whether a prior authorization or other restriction applies to the drug, view a detailed record of all prescription fills as well as copays paid (if applicable), and more. Visit the MaxorPlus website to create your profile.

What is my Group Number?
When you create a profile on the MaxorPlus site, you will be asked to enter a “Group #” – this is your Group ID, which you can find on your Member ID card, next to where it says “Group.” The IDs for each of our programs are as follows: Medicaid = MDC; Child Health Plus = CHP; Family Health Plus = FHP

What is covered under my pharmacy benefit?
For a list of drugs covered under the pharmacy benefit, review the Formulary for your type of coverage (Child Health Plus, Family Health Plus, or Medicaid). While the drugs listed on the formulary are not completely inclusive, it does give a good representation of what is covered. When medically necessary and authorized by a professional licensed to write prescriptions, Hudson Health Plan will pay for FDA approved items. Certain restrictions, quantity limits, or prior authorizations may apply to some medications. Over-the-counter drugs are covered, with a written prescription, if listed on the Child Health Plus drug formulary. Below are the excluded drugs for each type of coverage (Child Health Plus, Family Health Plus, or Medicaid)*:

Child Health Plus Exclusions

  • Anti-wrinkle agents
  • Blood
  • Blood clotting factors
  • Cosmetic hair removal products
  • Depigmenting agents
  • Drugs for erectile dysfunction
  • Drugs for cosmetic uses
  • Fertility agents
  • Hair growth stimulants
  • Homeopathic or natural legend products
  • Immunizations/vaccines/toxoids**
  • Lotrisone
  • Over the counter (OTC) drugs not listed on the NY State Medicaid formulary

Family Health Plus Exclusions

  • Anti-wrinkle agents and topical tretinoins when being used for cosmetic purposes. Tazorac is covered only if it’s being used to treat psoriasis (PA required)
  • Blood
  • Cosmetic hair removal products
  • Clotting Factors (covered by the state of New York)
  • Covered outpatient drugs when the manufacturer seeks to require, as a condition of sale, associated tests or monitoring services be purchased exclusively from the manufacturer or its designee
  • Depigmenting agents
  • DME & Medical Supplies (except diabetic supplies, hearing aid batteries, and enteral formula)
  • Drugs for Erectile Dysfunction
  • Drugs indicated for cosmetic uses
  • Drugs or supplies used for gender reassignment
  • Makena (or 17P, when compounded) – covered as a medical benefit
  • Most fertility agents (oral and injectable) – clomiphene is covered
  • Hair growth stimulants
  • Homeopathic/natural legend products
  • Immunizations/Toxoids/Vaccines**
  • Lotrisone
  • Non-legend drugs (OTC’s), unless listed on the New York State Medicaid Preferred Drug List
  • Weight loss, weight gain, and anorexia drugs

Medicaid Exclusions

  • Anti-wrinkle agents and topical tretinoins when being used for cosmetic purposes
  • Blood
  • Clotting Factors (covered by the state of New York)
  • Cosmetic hair removal products
  • Covered outpatient drugs when the manufacturer seeks to require, as a condition of sale, associated tests or monitoring services be purchased exclusively from the manufacturer or its designee
  • Depigmenting agents
  • Drugs for Erectile Dysfunction
  • Drugs indicated for cosmetic uses
  • Drugs or supplies used for gender reassignment
  • Makena (or 17P, when compounded) – covered as a medical benefit
  • Most fertility agents (oral and injectable) – clomiphene is covered
  • Hair growth stimulants
  • Homeopathic/natural legend products
  • Immunizations/Toxoids/Vaccines (except pharmacist-administered flu vaccines for those 18 years of age and older)**
  • Lotrisone
  • Non-legend drugs (OTC’s), unless listed on the NYS Medicaid Formulary
  • Weight loss, weight gain, and anorexia drugs

*This is not intended to be a full explanation of benefits, limitations, or exclusions. For more comprehensive information, please contact Maxor Plus Customer Service at 1-800-687-0707.

**For information about reimbursement for child vaccines through the Vaccines for Children program, please contact Hudson Health Plan Customer Care at 1.800.339.4557.