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NYRx, the Medicaid Pharmacy Program

NYRx Education & Outreach

Electronic PA Requests

Beginning Summer 2025, NYRx, the Medicaid Pharmacy Program, will accept electronic PA requests via CoverMyMeds®. For more information, reach out to NYRxEO@primetherapeutics.com.

NYRx Education & Outreach

About Us

The NYRx Education and Outreach (E&O) team serves as a liaison between stakeholders (such as Prescribers, Pharmacies, and Managed Care Plans) and New York State Department of Health to support care coordination and provide informing materials, trainings, and timely communications regarding NYRx, the Medicaid Pharmacy Program.

NYRx E&O supports and helps solve complex pharmacy cases for:

  • Managed Care Plans
  • Case workers and New York State agencies
  • Prescribers and pharmacies with questions regarding NYRx drug coverage, prior authorization requirements, and NYRx enrolled pharmacies
  • Complex care coordination for populations including but not limited to youth who are in Foster Care and those living with HIV/AIDS, bleeding disorders such as Hemophilia, Serious Mental Illness, Substance Use Disorder, and Hepatitis C.

Contact Us

The NYRx Education & Outreach Call Center is available 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. For privacy and security, Protected Health Information (PHI) sent through email must be encrypted.

Office Hours

The NYRx E&O team hosts virtual support drop-in sessions daily during the week for stakeholders to hop in and ask questions when support is needed.

Managed Care Organization (MCO) Office Hours:

Providers and Pharmacies Office Hours:

Trainings

The NYRx E&O team hosts weekly live training webinars providing an overview of NYRx, the Medicaid Pharmacy Program.

Registration is required to join.

Prescriber webinar occurs on Mondays. View the calendar with upcoming dates and registration links.

Pharmacy webinar occurs on Wednesdays. View the calendar with upcoming dates and registration links.

NYRx, the Medicaid Pharmacy Program overview webinar occurs on Fridays. View the calendar with upcoming dates and registration links.

Each webinar is from 12:00 PM - 1:00 PM ET, excluding holidays. To receive an invitation to join a webinar, please send an email request to NYRxEO@primetherapeutics.com.

In addition, recorded sessions of NYRx E&O educational webinars are available on the NYRx E&O YouTube channel. To view a specific webinar or for a copy of the slides select from the list below.

Resources

NYRx Newsletters
Title
March 2025 - Month in Review
February 2025 - Month in Review
January 2025 - Month in Review
December 2024 - Month in Review
Publications
Date Title
04/01/25 NYRx Electronic Prior Authorization via CoverMyMeds Summer 2025
03/14/25 NYRx Formulary Update: Hydroxym (hydrocortisone gel)
03/14/25 NYRx Formulary Update: Tirosint®
03/14/25 NYRx Drug Class Coverage Overview: Triglyceride Lowering Agents
01/01/25 NYRx Formulary Update: Nucynta and Xtampza
12/06/24 NYRx Drug Class Coverage Overview: Immunomodulators - Topical
11/26/24 NYRx 90-Day Supply Update
10/14/24 NYRx Highlight: Respiratory Syncytial Virus
10/11/24 NYRx Notice to Prescribers: Prior Authorization Submission Requirements
10/02/24 NYRx Reminder to Providers: Aripiprazole, Quetiapine, and Risperidone Diagnosis Requirements
07/17/24 NYRx Pharmacy Rejections - How to Identify and Resolve
07/02/24 NYRx Pharmacy Reminder: SMAC Price Research Requests and NYRx Reimbursement
06/21/24 NYRx, the Medicaid Pharmacy Program Information for Medical Residents
06/21/24 NYRx, the Medicaid Pharmacy Program Information for Pharmacies
06/10/24 NYRx Billing Guidance: Non-Patient-Specific Orders
06/06/24 NYRx Drug Class Coverage Overview: HIV Post-Exposure Prophylaxis Agents
05/29/24 NYRx Third-Party Liability and Coordination of Benefits
04/04/24 NYRx Drug Class Coverage Overview: Proton Pump Inhibitors
04/04/24 NYRx Notice to Providers and Pharmacies: Claim Submission with ICD-10
04/03/24 NYRx Drug Class Coverage Overview: Antimigraine Agents
03/13/24 NYRx Drug Class Coverage Overview: Skeletal Muscle Relaxants
03/01/24 NYRx Drug Class Coverage Overview: Central Nervous System Stimulants and Other Agents for Attention Deficit Hyperactivity Disorder
02/29/24 NYRx Drug Class Coverage Overview: Benzodiazepines
02/08/24 NYRx Drug Class Coverage Overview: Pubertal Suppressants and Hormone Replacement Therapy for Treatment of Gender Dysphoria
02/07/24 NYRx and NYS Medicaid DMEPOS Nebulizers
02/07/24 NYRx Opioid Dependence Agents
02/06/24 NYRx Notice to Prescribers: Coverage of Antiretroviral Agents for HIV Treatment and HIV Pre-Exposure Prophylaxis
02/02/24 NYRx Drug Class Coverage Overview: Immunomodulators - Systemic and Benlysta
01/22/24 NYRx Drug Class Coverage Overview: HIV Pre-Exposure Prophylaxis Agents
01/11/24 NYRx Drug Coverage Overview: Albuterol HFA
01/03/24 NYRx Prior Authorization Submission Guide
12/14/23 NYRx Preferred Diabetic Agents
12/07/23 NYRx Drug Class Coverage Overview: Sodium Glucose Co-Transporter 2 Inhibitors
11/30/23 NYRx Authorized Prescribers for Medicaid Members Reminder to Pharmacy Providers
11/30/23 NYRx Drug Class Coverage Overview Antipsychotics Second Generation
11/22/23 NYS Medicaid Enteral Prior Authorization - Prescribers, DME Providers and Pharmacies
11/09/23 NYS Medicaid Practitioner-Administered Drugs Frequently Asked Questions
11/08/23 NYRx Drug Class Coverage Overview: Long-Acting Opioids
10/23/23 NYRx Durable Medical Equipment, Prosthetics, Orthotics and Supplies
10/20/23 NYRx Prescription Requirements & Regulations
10/20/23 NYRx Notice to Providers: Duplicate Prior Authorization Requests
10/16/23 NYRx Out-of-State Traveling
10/03/23 NYRx Vaccine Billing
09/19/23 NYRx Drug Class Coverage Overview: Short Acting Opioids
09/13/23 NYRx Drug Class Coverage Overview: Glucagon-Like Peptide-1 (GLP-1) Agonists
08/21/23 NYRx Excluded Diagnoses
07/18/23 NYRx, Drug Utilization Review (DUR) FAQ
07/18/23 NYRx, Drug Utilization Review (DUR) Program
07/18/23 NYRx, Preferred Drug Program (PDP)/Preferred Drug List (PDL), FAQ
07/18/23 NYRx, Preferred Drug Program (PDP)/Preferred Drug List (PDL) Overview
07/13/23 NYRx Program Review Notice
07/07/23 NYRx Brand Less Than Generic (BLTG) Program
07/07/23 NYRx Brand Less Than Generic (BLTG) FAQ
06/23/23 NYRx Dose Optimization (DO)
06/23/23 NYRx Frequency/Quantity/Duration (FQD)
06/23/23 NYRx Step Therapy (ST)
04/28/23 NYRx Education and Outreach for Managed Care Organizations (MCOs)
04/28/23 NYRx Education and Outreach for Providers