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Pharmacy Specific

  • New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage - (Web) - (PDF)
  • New York State (NYS) Medicaid Fee-For-Service (FFS) Policy and Billing Guidance for COVID-19 Testing and Specimen Collection at Pharmacies - (Web) - (PDF) - (Updated 12.16.23)
  • Per the U.S. Department of Health and Human Services (HHS) coverage for commercial Paxlovid products for NY Medicaid members will be accessed through the Pfizer patient assistance program through the end of 2024. NY Medicaid will not be adding any commercial Paxlovid products to the formulary file due to this access. More information regarding commercial Paxlovid and other oral antivirals is found here.
  • Reminder: Pharmacy Provider Options Available for the COVID-19 and Influenza 2023-2024 Vaccine Season - (Web) - (PDF) - 10.26.2023
  • New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage - (PDF) - (Updated 7.12.2023)
  • New York State (NYS) Medicaid Policy and Billing Guidance for Reimbursement of COVID-19 Therapeutics Dispensing or Administration at Pharmacies - (PDF) - (Updated 3.24.2023)
  • New York State Medicaid Policy and Billing Guidance for Pharmacy Reimbursement of COVID-19 Oral Antivirals - (Web) - Updated 11.8.22
  • COVID-19 Vaccine Administration Billing Guidance for Managed Long-Term Care Members without Medicare Coverage - (PDF) - Updated 2.3.2022
  • Guidance for Medicaid Pharmacies Regarding the End of the Declared Disaster Emergency in the State of New York over COVID-19 - (PDF) - Updated 7.8.2021
    • Please note: Facilities unable to confirm receipt of delivery of medications by signature, may alternatively provide confirmation by a phone call, text or email in accordance with state and federal laws, in lieu of providing a signature. Such confirmation should be documented and retrievable upon audit by the delivering provider. This alternative confirmation of receipt of medication deliveries to facilities will be in effect until further notice. (Effective September 13, 2022, in accordance with the end of the State Disaster Emergency initially declared on March 7, 2020 to fight COVID-19, this guidance has expired.)
  • Guidance for Medicaid Pharmacies Regarding the Declared Disaster Emergency in the State of New York over COVID-19 - (PDF) - Updated 4.6.2020 (Effective July 9, 2021, in accordance with the end of the State Disaster Emergency declared on March 7, 2020 to fight COVID-19, this guidance has expired.)