Pharmacy
NH Healthy Families is committed to providing appropriate, high-quality, and cost-effective drug therapy to all NH Healthy Families members. NH Healthy Families covers prescription and certain over-the-counter medications with a written order from a NH Healthy Families provider. Not all medications are covered by the pharmacy program. Some medications may require prior authorization or may have age, dosage or quantity limitations. Please use the below Preferred Drug List to find more information on the drugs that are covered
NH Healthy Families Preferred Drug List (PDF)
Machine-Readable File (JSON)
- NH Healthy Families Preferred Drug List Machine Readable File (JSON)
In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524), NH Healthy Families has made public the preferred drug list in a machine-readable file format (MRF).
Members have the option to receive a 90-day supply of their maintenance medications at in-network pharmacies.
NH Healthy Families also has in network mail-order pharmacies available to our membership to ensure timely delivery of medications. For additional information please reach out to NH Healthy Families at 866-769-3085, Monday through Friday 8 a.m. to 5 p.m.
Prior Authorization Criteria
NH Healthy Families Medical and Pharmacy Policies.
NH Healthy Families Prescription Prior Authorization FAQ’s (PDF).
Medication Requests
Submit a secure electronic Prior Authorization request for any of the below forms through Cover My Meds here.
Pharmacy Services processes pharmacy claims for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs. For self-administered medications, submit a secure electronic Prior Authorization request through Cover My Meds here or use the medication request form(s) below:
- Medication Prior Authorization form (PDF)
- Specialty Medication Request Form (PDF)
- Behavioral Health Prior Authorization Form for Community Mental Health Center Providers (PDF)
Provider Help Desk:
NH Healthy Families Oncology Management Program
NH Healthy Families is pleased to collaborate with New Century Health (NCH), an oncology quality management company, to implement a new oncology pre-approval program, NH Healthy Families Oncology Pathway Solutions. The program simplifies the administrative process for providers to support the effective delivery of quality patient care.
As of May 1, 2020, all oncology-related chemotherapeutic drugs and supportive agents require clinical review by NCH before being administered in a physician’s office, outpatient hospital or ambulatory setting. This prior authorization requirement applies to both pharmacy dispensed and office administered medication requests for all NH Healthy Families Medicaid members.
NH Healthy Families Oncology Pathway Solutions program benefits include:
- The use of clinical criteria, based on nationally-recognized guidelines, to promote evidence-based cancer care.
- Increased collaboration with physician offices to foster a team approach.
- Peer-to-peer discussions with medical oncologists who can understand and better discuss treatment plans.
- A provider web portal to:
- Obtain real-time approvals when selecting evidence-based NCH treatment care pathways.
- Determine which clinical documentation is necessary for medical necessity review.
- View all submitted requests for authorization in one location.
- Check member eligibility.
Pre-approval Process
- The requesting physician must complete an authorization request using one of the following methods:
- Logging into the NCH Provider Web Portal
- Calling 1-888-999-7713, Option 1, Monday–Friday (8 a.m. - 8 p.m. ET)
Pharmacy Policy and Formulary Changes
- New Century Health Policy Changes November 2023 (PDF)
- New Century Health Policy Changes October 2023 (PDF)
- New Century Health Policy Changes September 2023 (PDF)
- New Century Health Policy Changes August 2023 (PDF)
- New Century Health Policy Changes July 2023 (PDF)
- New Century Health Policy Changes June 2023 (PDF)
- New Century Health Policy Changes May 2023 (PDF)
- New Century Health Policy Changes April 2023 (PDF)
- New Century Health Policy Changes March 2023 (PDF)
- New Century Health Policy Changes February 2023 (PDF)
- New Century Health Policy Changes January 2023 (PDF)
- New Century Health Policy Changes December 2022 (PDF)
- New Century Health Policy Changes November 2022 (PDF)
- New Century Health Policy Changes October 2022 (PDF)
- New Century Health Policy Chnages September 2022 (PDF)
- New Century Health Policy Changes August 2022 (PDF)
- New Century Health Policy Changes July 2022 (PDF)
- New Century Health Policy Changes June 2022 (PDF)
- New Century Health Policy Changes May 2022 (PDF)
- New Century Health Policy Changes April 2022 (PDF)
- New Century Health Policy Changes March 2022 (PDF)
- New Century Health Policy Changes February 2022 (PDF)
- New Century Health Policy Changes January 2022 (PDF)
- New Century Health Policy Changes December 2021 (PDF)
- New Century Health Policy Changes November 2021 (PDF)
- New Century Health Policy Changes October 2021 (PDF)
- New Century Health Policy Changes September 2021 (PDF)
- New Century Health Policy Changes August 2021 (PDF)
- New Century Health Policy Changes July 2021 (PDF)
- New Century Health Policy Changes June 2021 (PDF)
- New Century Health Policy Changes May 2021 (PDF)
- New Century Health Policy Changes April 2021 (PDF)
- New Century Health Policy Changes March 2021 (PDF)
- New Century Health Policy Changes February 2021 (PDF)
- New Century Health Policy Changes January 2021 (PDF)
- New Century Health Policy Changes December 2020 (PDF)
- New Century Health Policy Changes November 2020 (PDF)
- New Century Health Policy Changes October 2020 (PDF)
- New Century Health Policy Changes September 2020 (PDF)
- New Century Health Policy Changes August 2020 (PDF)
- New Century Health Policy Changes July 2020 (PDF)
- New Century Health Policy Changes June 2020 (PDF)
- New Century Health Policy Changes May 2020 (PDF)
- New Century Health Policy Changes April 2020 (PDF)
- New Century Health Policy Changes March 2020 (PDF)
- New Century Health Policy Changes February 2020 (PDF)
- New Century Health Policy Changes January 2020 (PDF)
- 4th Quarter 2023 Pharmacy Policies Summary (PDF)
- 3rd Quarter 2023 Pharmacy Policies Summary (PDF)
- 2nd Quarter 2023 Pharmacy Policies Summary (PDF)
- 1st Quarter 2023 Pharmacy Policies Summary (PDF)
- 4th Quarter 2022 Pharmacy Policies Summary (PDF)
- 3rd Quarter 2022 Pharmacy Policies Summary (PDF)
- 2nd Quarter 2022 Pharmacy Policies Summary (PDF)
- 1st Quarter 2022 Pharmacy Policies Summary (PDF)
- 4th Quarter 2021 Pharmacy Policies Summary (PDF)
- 3rd Quarter 2021 Pharmacy Policies Summary (PDF)
- 2nd Quarter 2021 Pharmacy Policies Summary (PDF)
- 1st Quarter 2021 Pharmacy Policies Summary (PDF)
- 4th Quarter 2020 Pharmacy Policies Summary (PDF)
- 3rd Quarter 2020 Pharmacy Policies Summary (PDF)
- 2nd Quarter 2020 Pharmacy Policies Summary (PDF)
- 1st Quarter 2020 Pharmacy Policies Summary (PDF)
- 4th Quarter 2019 Pharmacy Policies Summary (PDF)
- 3rd Quarter 2019 Pharmacy Policies Summary (PDF)
- 2nd Quarter 2019 Pharmacy Policies Summary (PDF)
- 1st Quarter 2019 Pharmacy Policies Summary (PDF)