Member Important Updates on NYRx, the Medicaid Pharmacy Benefit

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Subject: Important Updates on NYRx, the Medicaid Pharmacy Benefit
Dear Members, We hope this communication finds you well. We have news about NYRx. Your health matters to us, and we want to give you the latest information to help you manage your drugs and supplies. What is NYRx? NYRx is your New York Medicaid pharmacy benefit. NYRx covers your prescription drugs and supplies, and some over-the-counter items. To see what's covered under the NYRx program, visit https://member.emedny.org/.
Key Updates
Changes to Coverage of Phosphate Binder Medications for Patients on Kidney Dialysis: Starting January 1, 2026, the way New York State Medicaid covers drugs that remove phosphate from the body (phosphate binder drugs), for patients on kidney dialysis will change. These drugs will still be covered by Medicaid but will be provided by your dialysis clinic, not the pharmacy. The following is a list of phosphate binder drugs you will get from your dialysis clinic or facility: calcium acetate Auryxia™ ferric citrate Fosrenol® lanthanum carbonate Renvela® sevelamer carbonate sevelamer HCl Velphoro® Xphozah® How will you get these drugs? You will still be able to get these drugs, but they will come directly from your dialysis clinic or facility not the pharmacy. Talk to your dialysis clinic or facility to get these medicines.
Extra Information Needed for Certain Drugs: Starting December 18, 2025, the following drugs will no longer be covered by NYRx without your doctor requesting approval. These drugs have alternate options available that do not require more information. Talk to your doctor or pharmacist about alternative drugs that do not require approval. Drugs that will need this additional information: Carbinoxamine Maleate 6 mg Tablet Chlorzoxazone 250 mg Tablet Diclofenac Potassium 25 mg Tablet Dolobid 250 mg Tablet Halcinonide 0.1% Solution Hydrocortisone 2.5% Solution Meloxicam 5 mg and 10 mg Capsule Metformin HCl 750 mg (IR) Tablet Relafen DS 1,000 mg Tablet Tetracycline 250 mg Tablet Tolectin 600 mg Tablet Tolmetin Sodium 400 mg Capsule How will you get these drugs? You will still be able to get these drugs, but your doctor will have to submit additional information showing a clear health-related reason for use. Talk to your doctor or pharmacist to get more information.

Questions? We're Here to Help!
If you have any questions regarding your pharmacy benefits or NYRx, please call the Medicaid Helpline at (800) 541-2831. Our agents are available: Monday through Friday, 8 AM to 8 PM Saturday, 9 AM to 1 PM. TTY 1-800-662-1220. We also provide help in different languages. Thank you, NYRx, Medicaid Pharmacy Program New York State Department of Health