Medicaid Managed Care Plan Information
As of April 1, 2023, all Medicaid members enrolled in Mainstream Managed Care receive their prescription drugs through NYRx, the Medicaid Pharmacy Program instead of through their Medicaid Managed Care Plan.
Managed Care Plans continue to be responsible for maintaining all activities necessary for their enrolled members' care coordination and claims payment for non-outpatient pharmacy services and related activities, consistent with contractual obligations. Information regarding Managed Care Plan and NYS DOH roles and coverage can be found within the NYRx Roles & Responsibilities document as well as the NYRx Scope of Benefits.
Managed Care Plans
The Client Identification Number or CIN is a unique number assigned to each Medicaid recipient. This number is used by the pharmacy and other providers to submit claims to NYRx. All Medicaid recipients are assigned a unique CIN even if they are enrolled in a Medicaid managed care (MMC) plan. The CIN is located on all member cards including MMC plan cards. On some MMC cards it’s called CIN however other MMC cards may identify it as Program ID, Member ID, or ID#. While in some cases it may be embedded into a longer number the CIN is always represented in this format: AA11111A.
Affinity by Molina
Customer Service: For questions regarding policy and coverage information, call 1-800-223-7242 (TTY: 711).
Important Guidance and Information:
- Affinity Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Amida Care
Customer Service: For questions regarding policy and coverage information, call 1-800-556-0689 (TTY: 711).
Important Guidance and Information:
- Amida Care Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Anthem Blue Cross Blue Shield
Customer Service: For questions regarding policy and coverage information, call 1-800-300-8181 (TTY: 711).
Important Guidance and Information:
- Anthem Blue Cross Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Capital District Physicians Health Plan (CDPHP)
Customer Service: For questions regarding policy and coverage information, call 1-800-388-2994 (TTY: 711).
Important Guidance and Information:
EmblemHealth
Customer Service: For questions regarding policy and coverage information, call 1- 855-283-2146 (TTY: 711).
Important Guidance and Information:
- EmblemHealth Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Excellus
Customer Service: For questions regarding policy and coverage information, call 1- 800-650-4359 (TTY: 711).
Important Guidance and Information:
- Excellus Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Fidelis Care
Customer Service: For questions regarding policy and coverage information, call 1-888-343-3547 (TTY: 711).
Important Guidance and Information:
- Fidelis Care Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
HealthFirst
Customer Service: For questions regarding policy and coverage information, call 1-866-463-6743 (TTY: 1-888-542-3821).
Important Guidance and Information:
- HealthFirst Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Highmark Blue Cross Blue Shield of Western New York
Customer Service: For questions regarding policy and coverage information, call 1-866-231-0847 (TTY: 711).
Important Guidance and Information:
- Highmark Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Independent Health
Customer Service: For questions regarding policy and coverage information, call 1-833-891-9372 (TTY: 711).
Important Guidance and Information:
- Independent Health Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
MetroPlusHealth
Customer Service: For questions regarding policy and coverage information, call 1-800-303-9626 (TTY: 711).
Important Guidance and Information:
- MetroPlusHealth Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Molina Healthcare
Customer Service: For questions regarding policy and coverage information, call 1-800-223-7242 (TTY: 711).
Important Guidance and Information:
- Molina Healthcare Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
MVP Health Care
Customer Service: For questions regarding policy and coverage information, call 1-800-852-7826 (TTY: 711).
Important Guidance and Information:
- MVP Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
UnitedHealthcare
Customer Service: For questions regarding policy and coverage information, call 1-800-493-4647 (TTY: 711)
Important Guidance and Information:
- UnitedHealthcare Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Univera Healthcare
Customer Service: For questions regarding policy and coverage information, call 1-800-650-4359 (TTY: 711).
Important Guidance and Information:
- Univera Healthcare Medicaid Benefit Information
- Physician-Administered Drug Policy and Billing Guidance
- Physician Dispenser Billing Guidance
Visiting Nurse Service of New York (VNSNY)
Customer Service: For questions regarding policy and coverage information, call 1-866-469-7774 (TTY: 711).
Important Guidance and Information:
Additional Resources
NYRx Resources
- NYRx List of Reimbursable Drugs
- NYRx DUR Program Information
- NYRx Preferred Drug List and Prior Authorization Program
New York Medicaid Resources
- New York State Medicaid and Managed Care
- New York State Medicaid Managed Care Model Contract (pdf)
- New York State Medicaid Program
- New York State Opioid Management Resources
Other Resources
Contact Information
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If you have questions about your eligibility or to find out which managed care plan you are enrolled in, you can call the Medicaid Helpline in your preferred language:
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If you would like to receive updates about the NYRx Medicaid Pharmacy Program, you can subscribe to the NYRx Listserv. |
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