Welcome to the NY Medicaid Pharmacy Program (NYRx)
Information about Medicaid's Prescription Drug Benefit and Changes Effective April 2023
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As of April 1, 2023, all Medicaid members enrolled in Mainstream Managed Care receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. NYRx allows New York State to pay pharmacies directly for the drugs and supplies of Medicaid members.
Prior to April 1, 2023, Mainstream Medicaid members accessed their pharmacy benefits through a health plan, rather than Medicaid Fee-For Service (NYRx). This includes anyone in Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs Plans (HIV-SNPs). In this case, the state reimburses the health plan rather than the pharmacy.
Moving all Medicaid members under the NYRx Program allows for a single, uniform list of covered drugs and standardized, consistent rules and regulations. Thus, New York State is able to offer an improved, simplified process for Medicaid members to get the medicines and supplies they need. Medicaid members have comprehensive drug coverage and equitable access to an extensive network of over 5,000 pharmacy providers.
This transition does not apply to Managed Long Term Care plans (e.g., PACE, MAP, MLTC) or the Essential Plan.
We are committed to providing effective communication to all Medicaid members, pharmacies and providers.
Please see the Navigation Bar to the left for more information, FAQs, guidance and resources.
Contact Information
By email: NYRx@health.ny.gov. | By phone: The Medicaid Helpline can help you in your preferred language: (800) 541-2831 Open Monday - Friday, 8 am - 8pm and Saturday, 9am - 1 pm |
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