Provider Tool Kit

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Provider Tool Kit

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Medication Prior Authorization Request Forms

Medication Request Forms (For Medicare and FIDA Complete) 

Drug Coverage and Exceptions
In certain cases, a provider may determine that a member requires a non-covered prescription. When this occurs, you may request an exception from the formulary by completing an "Exception Request Form" or by calling MedImpact Healthcare Systems. Please visit our Forms for Providers section for copies of the following forms:

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

Last updated 10/17/2018

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Find a physician, pharmacy or other provider in the VNSNY CHOICE network.

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