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NYS Medicaid Pharmacy Programs

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Current Pharmacy Programs and Updates

Recent Pharmacy News

April 2021

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

March 2021

NOTICE! Medicaid Update Special Edition - Part Two: Medicaid Pharmacy Carve-Out The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

Attention: COVID-19 Vaccine Administration Billing Guidance for Managed Long-Term Care Members without Medicare Coverage

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

NOTICE! Medicaid Update Special Edition - Part One: Medicaid Pharmacy Carve-Out The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

November 2020

NOTICE! Attention: Pharmacies and DME, Prosthetics, Orthotics and Supply Providers, and Prescribers Not Enrolled in Medicaid Fee-for-Service (FFS) The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

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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