Prior Authorization Forms
Senior Whole Health of New York requires you, or your physician, to get prior authorization for certain drugs. This means that you will need to get approval from us before you fill your prescriptions. If you don't get approval, we may not cover the drug.
The following document provides a list of drugs that require Prior Authorization.
Effective July 1, 2019
Download the Senior Whole Health of New York 2019 Prior Authorization Criteria (PDF).
Drug Determination Forms
Download the Drug Coverage Determination Form (PDF) in ENGLISH.
Last Updated 07/01/2019
H5992_2015_099 Approved 10/16/2014