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NYS Medicaid Pharmacy Programs

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Current Pharmacy Programs and Updates

Managed Care (MCO) to FFS Pharmacy Benefit Transition Effective 04/01/2021
Preferred Drug List
Preferred Drug Program
Brand Less Than Generic Program
Dose Optimization Initiative
Drug Utilization Review Board (DURB) Recommendations
Preferred Diabetic Supply Program
Single State Supplemental Rebate Agreements (SRAs) for Preferred Anti-Retrovirals (ARVs)
SMAC Program

Recent Pharmacy News

February 2021

New York State (NYS) Medicaid Fee-for-Service (FFS) Policy and Billing Guidance for COVID-19, Influenza and RSV Testing and Specimen Collection at Pharmacies as of 02/18/2021

January 2021

Medicaid Pharmacy Prior Authorization Programs Update - Effective February 4, 2021

December 2020

Medicaid Update Special Edition - Part One: Medicaid Pharmacy Carve-Out

November 2020

Attention: Pharmacies and DME, Prosthetics, Orthotics and Supply Providers, and Prescribers Not Enrolled in Medicaid Fee-for-Service (FFS)

UPDATE: Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists

October 2020

Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists Effective December 1, 2020

September 2020

New York State (NYS) Medicaid Fee-for Service (FFS) Policy and Billing Guidance for COVID-19 Testing and Specimen Collection at Pharmacies As of 09/18/2020

Medicaid Pharmacy Prior Authorization Program Update Effective 10/08/2020

Prior Authorization Resources

To obtain a prior authorization call (877) 309-9493 or fax the appropriate Prior Authorization form to (800) 268-2990.

PAXpress is a web-based application available for initiating prior authorization requests.

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