For Providers/Prescribers and Pharmacists
NY Medicaid Pharmacy Program (NYRx) Information for Providers
Effective April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will receive their pharmacy benefits through the Medicaid Fee-for-Service (FFS) Pharmacy Program instead of through their Medicaid MC plan as they do now. The transition does not apply to members enrolled in Managed Long-Term Care plans (e.g., MLTC, PACE and MAP), the Essential Plan, or Child Health Plus (CHP).
Transitioning the pharmacy benefit from MC to FFS will provide the State with full visibility into prescription drug costs, allow centralization of the benefit, leverage negotiation power, and provide a single drug formulary with standardized utilization management protocols simplifying and streamlining the drug benefit for Medicaid members.
- Pharmacy Benefits Affected by Transition from Managed Care
- Information for Pharmacies
- Information for Prescribers
- Information for Providers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
- Frequently Asked Questions (FAQs)
- If you need help or have questions, please contact us:
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| By email: NYRx@health.ny.gov. |
Medicaid helplines for providers
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