Hudson Health Plan

Hudson Health Plan Drug Information

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

Pharmacy Benefits

Medicaid and Family Health Plus members 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 the 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 MaxorPlus Customer Service at 1.800.687.0707.

Drug Formularies

A formulary is a list of covered medications 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.

Access Quick Reference and Formulary Guides.

Drug 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 (Medicaid, Family Health Plus, or Child Health Plus).

Please refer to the following chart to see if you might be required to pay a co-payment.

Drug 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 MaxorPlus Customer Service at 1.800.687.0707.

The following is a list of items requiring prior authorization.

Specialty Medications

Specialty medicines are used to treat chronic conditions such as cancer, multiple sclerosis, and rheumatoid arthritis and other autoimmune diseases. These medicines often require special handing and distribution. They also can require patient management and counseling.

Learn more about Maxor and specialty medications.

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 at 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 at 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 MaxorPlus Customer Care at 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 co-pay 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 co-pays 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; Family Health Plus = FHP; Child Health Plus = CHP.

What is covered under my pharmacy benefit?
For a list of medications covered under the pharmacy benefit, review the Drug Formulary for your type of coverage; Medicaid, Family Health Plus, or Child Health Plus. (See Specialty Medications regarding medicines used to treat chronic conditions.) While the drugs listed in each 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 (Medicaid, Family Health Plus, or Child Health Plus)*:

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

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

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

*This is not intended to be a full explanation of benefits, limitations, or exclusions. For more comprehensive information, please contact MaxorPlus 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.