Member Important Updates on NYRx, the Medicaid Pharmacy Benefit
- Notice is also available in Portable Document Format (PDF)
| Subject: Important Updates on NYRx, the Medicaid Pharmacy Benefit | ||||||||||||||||||
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| 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 NYRx, the Medicaid Pharmacy Program Member Resources. |
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| Key Updates | ||||||||||||||||||
| Topical Compounded Drugs: Starting February 5th, 2026, NYRx will stop covering topical compounds made with drug ingredients that do not have proof that they are safe and effective when used on the skin. Topical compounded drugs are made by mixing multiple ingredients for a specific patient to put on their skin, such as a lotion or cream. The ingredients below have not been proven effective when used on the skin. Topical compounded drug ingredients not proven effective when used on the skin:
Most topical compounded drugs have safe and effective options approved by the FDA. NYRx has a list of f requently asked questions (FAQ) about your coverage of compounded drugs. You can read them here. How will you get these drugs? If you currently get a topical compounded drug that is not covered by NYRx, you should talk to your doctor or pharmacist about other drugs available. Doctors and pharmacies have been reminded of this policy and were made aware of this, so they should be switching you to safe and effective drugs covered by NYRx. You can f ind covered drugs on the NYRx member website here. If you cannot switch, then your doctor will need to submit additional information showing that the topical compound is safe and effective and that there is a clear health-related reason for use. Talk to your doctor or pharmacist to get more information. |
| Extra Information Needed for Certain High-Cost Medicines: Starting February 19, 2026, 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:
How will you get these drugs? You may 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. |
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| Important Reminders | ||||||||||||||||||||||||||||||||||||||||||||||||
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| Stay Up to Date:To review current and past member notifications for NYRx, visit the 'Member Notices' section of the eMedNY member website Important Information About Your NY Medicaid Benefits: Make sure NY State of Health has your current mailing address, phone number and email address so they can contact you about your health insurance. Update your contact information at: NY State of Health Keep Your Coverage so you know when to renew your coverage. |
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| 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:
TTY 1-800-662-1220. We also provide help in different languages. Thank you, NYRx, Medicaid Pharmacy Program New York State Department of Health |
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