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NYS Medicaid Pharmacy Programs

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Current Pharmacy Programs and Updates

NOTICE!  Effective October 1, 2021 NY Medicaid implemented a single statewide Medication Assisted Treatment (MAT) formulary for opioid dependence agents and opioid antagonists for NYS Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC).

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)
NEW! Single Statewide Medication Assisted Treatment (MAT) Formulary
SMAC Program

Recent Pharmacy News

November 2021

Clozapine Risk Evaluation and Mitigation Strategy (REMS) Certain Program Requirements Temporarily Suspended

October 2021

Attention Medicaid Fee-for Service (FFS) Providers: Brand Less than Generic Update-Suboxone Film

Clozapine Risk Evaluation and Mitigation Strategy Requires Providers and Pharmacies to Re-certify/Re-enroll Patients by November 15, 2021

Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists - New Information

September 2021

Medicaid Pharmacy Prior Authorization Programs Update - Effective October 28, 2021

Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists - Effective October 1, 2021

July 2021

Medicaid Pharmacy Prior Authorization Programs Update - Effective August 26, 2021

Medicaid Pharmacy Guidance Regarding the End of the Declared Disaster Emergency in the State of New York - COVID-19

June 2021

Attention Pharmacy Providers - Important Information Regarding Drug Shortages as of June 2021

May 2021

NOTICE! The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

Medicaid Pharmacy Prior Authorization Program Updates – Effective June 24, 2021

April 2021

Attention All Providers: The Pharmacy Carve-Out Has Been Delayed by Two Years, until April 1, 2023

Medicaid Pharmacy Prior Authorization Programs Update - Effective April 22, 2021

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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