NYRx, the Medicaid Pharmacy Program

Cost Optimization Program

About

In December 2025, NYRx, the Medicaid Pharmacy program initiated a cost optimization program. This program focuses on new formulations and dosages of older drug products that are disproportionately priced to other strengths of the same drug or similar drugs in the same drug class without any additional clinical benefit. Prescribers are encouraged to achieve the desired dose by using multiple or half of the lower cost strength or choosing the lower cost formulation (e.g., tablets versus capsules) or choosing a lower cost therapeutic comparable drug in the same drug class. If a prescriber has determined that one of these drugs is the only appropriate treatment for a Medicaid member, they may submit a letter of medical necessity and supporting documentation to the Department. The letter must accompany patient chart notes and peer reviewed medical literature that supports the use of the requested drug unit strength or dosage form. This information should be sent to NYRx@health.ny.gov. A review will be conducted once all the listed information is received.

Drugs in the Cost-Op program that are also included in another NYRx, Medicaid pharmacy program will be identified with an “MR” after the drug on the Preferred Drug List. For example, Ibuprofen 300mg MR.

For questions about the Cost Optimization Program, or support with how to submit a PA, please contact the NYRx Education & Outreach team by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 AM to 5:00 PM ET, Monday through Friday, excluding holidays.

Cost Optimization Program Updates

Date
03/19/26
02/19/26