2019 Empire Plan Formulary

New York State has recently released the 2019 Empire Plan Advanced Flexible Formulary drug list for CSEA active State and Court System Empire Plan enrollees.  The creation of the Empire Plan Formulary is an administrative responsibility held by the New York State Department of Civil Service and the Empire Plan Prescription Drug Administrator, CVS Caremark.  During the creation of the formulary, all medications on the formulary (including generics) are evaluated for effectiveness and safety.

Generics should be considered the first line of prescribing.  If there is no generic available, there may be more than one brand-name drug to treat a condition.  Preferred brand-name drugs are listed within the formulary to help identify products that are clinically appropriate.  Please note that the 2019 Empire Plan Advanced Flexible Formulary is not an all-inclusive list; the formulary includes a list of commonly prescribed drugs covered by therapeutic class, a Quick Reference Drug List with commonly prescribed covered drugs in alphabetic order, a listing of commonly prescribed non-preferred (Level 3) covered drugs and covered preferred drug alternatives, and a listing of excluded drugs along with covered alternatives.  Brand name drugs in this list are in CAPS and generic drugs in lowercase italics.

During the annual review, drugs can change copayment tiers (resulting in either an increased or decreased copayment) or drugs can be excluded from coverage or re-introduced to coverage if they were previously excluded.

Empire Plan enrollees who may be negatively impacted by any changes to the Advanced Flexible Formulary will receive a letter with a list of alternative medications from CVS Caremark.

The Empire Plan offers a medical exception process for non-formulary drugs that are excluded from coverage.  To request a medical exception, you and your physician must first evaluate whether covered drugs on the Advanced Flexible Formulary are appropriate alternatives to your treatment.  After an appropriate trial of formulary alternatives, your physician may submit a letter of medical necessity to CVS Caremark that details the formulary alternative trials and any other clinical documentation supporting medical necessity.  The physician can fax the exception request to CVS Caremark at 1-888-487-9257.  If an exception is approved, the Level 1 copayment will apply for generic drugs and the Level 3 copayment (and ancillary charge, if applicable) will apply for brand-name drugs.

For specific information regarding your prescription benefit coverage and copay information, please visit https://www.empireplanrxprogram.com or call 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program.