Drug Formulary

HIP HEALTH PLAN OF NEW YORK
MAINTENANCE DRUG LIST

The Maintenance Drug List has been approved for the following disease states or drug categories. Drugs used in these disease states or included in these drug categories can be dispensed for up to a 90-day supply if prescribed. Disposable insulin needles and syringes may be dispensed in the full box of 100 even if it represents a 100-day supply. All medications are subject to member's rider benefit.

Please note, that not all drug classes are included on the Maintenance Drug List.

Amyotrophic Lateral Sclerosis
Androgenic Agents
Anticholinesterase Muscle Stimulants
Anticonvulsants - Non-Schedule
Antihyperlipidemic Agents
Asthma
Attention Deficit Hyperactivity Disorder
Benign Prostatic Hypertrophy
Cardiovascular Agents
Contraceptives
Crohn's Disease
Diabetic Agents & Supplies
           Disposable Insulin Needles & Syringes
           Insulin Therapy
           Oral Hypoglycemics
           Select Diagnostics
Diuretics
Glaucoma
Glucocorticoids
Gout
Histamine-2 Blockers
Inflammatory Bowel Disease
Osteoporosis
Parkinson's Disease
Phosphate Binders
Potassium Replacement Therapy
Proton Pump Inhibitors
Thyroid Therapy
Vitamins

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