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To submit a prior authorization (if required) please complete the prior authorization request form and fax it (along with any additional documentation required) to (833) 434-0563. Prior authorization request forms can also be sent via mail to the below address: Capital Rx Attention Prior Authorization Department 228 Park Ave S Suite 87234 New York, New York 10003-1502

To help with your prescribing decisions, included below is a quick reference formulary outlining coverage information for most Capital Rx members. This formulary document is not a complete list and is used to highlight coverage for the most commonly prescribed medications.

To help with your prescribing decisions, included below is a quick reference formulary outlining coverage information for most Capital Rx members. This formulary document is not a complete list and is used to highlight coverage for the most commonly prescribed medications.

Below is a list of medications that require prior authorizations. These medications require approval from your pharmacy benefit carrier before you receive care. If you do not get a prior authorization, a medication may cost you more, or it may not be covered.

Below is a list of medications that require prior authorizations. These medications require approval from your pharmacy benefit carrier before you receive care. If you do not get a prior authorization, a medication may cost you more, or it may not be covered.

The excluded medications below are not covered on the Capital Rx Liberty formulary medication list. This list is not inclusive of all excluded medications.

For a complete list of network pharmacies available to you, click the "Download PDF" button below. For additional pharmacy network questions, please call (888) 832-2779.