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NYRx, the Medicaid Pharmacy Program

NYRx Education & Outreach

NYRx Education & Outreach

On April 1, 2023, the prescription drug benefit for all Medicaid members enrolled in a Mainstream Managed Care Plan, Health and Recovery Plan (HARP), and HIV-Special Needs Plan (HIV-SNP) was transitioned to NYRx, the Medicaid Pharmacy Program. In addition to the existing Medicaid member and provider helplines, starting Monday, April 3, there is a dedicated team, led by Magellan, to support care coordination.

The Education and Outreach team serves as a liaison between the Managed Care Plans and NYRx to support care coordination. Clinical liaisons are trained to support and help 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 approval requirements, and NYRx enrolled pharmacies
  • Complex care coordination for populations such as HIV/AIDS, Hemophilia, Foster Care children, Serious Mental Illness, Substance Use Disorder, and Hepatitis C

To contact the Education and Outreach team call (833) 967-7310. The call center is available Monday through Friday 8am until 5pm ET.

NYRx program-related questions and non-member-specific questions can be emailed to NYRxEO@magellanhealth.com.

Office Hours

Virtual support drop-in sessions are offered every week for pharmacy stakeholders to ask questions related to NYRx and care coordination

  • Managed Care Organizations (MCOs) office hours hosted via Zoom from 12pm-1pm ET every Monday and Wednesday
  • Office hours hosted via Zoom from 12pm-1pm ET every Tuesday and Thursday for the following:
    • Pharmacy providers and prescribers
    • Office of Addiction Services and Supports (OASAS)
    • Office of Medicaid Inspector General (OMIG)
    • New York Blood Center
    • Foster Care
    • AIDS Institute and stakeholders

Trainings

The Education and Outreach team hosts weekly live training webinars which focus on different areas of the NYRx program.

Starting Friday, May 26, the webinar will focus on:

  • NYRx, the Medicaid Pharmacy Program Overview with a focus on the Preferred Drug Program (PDP), the Drug Utilization Review program (DUR) and the Brand Less than Generic program (BLTG)

Pharmacy providers and prescribers are encouraged to attend these webinars to learn more about NYRx. No registration is required to attend. Join the Education & Outreach team via Zoom every Friday from 12pm-1pm ET.

Prerecorded 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

Publications
Date Title
02/23/24 NYRx Drug Class Coverage Overview: Atopic Dermatitis Agents
02/08/24 NYRx Drug Class Coverage Overview: Hormone Replacement and Pubertal Suppressant 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
09/21/23 NYRx Respiratory Syncytial Virus Highlight
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