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NYRx, the Medicaid Pharmacy Program
Maximum Allowable Cost (MAC) Information
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.
Maximum Allowable Cost (MAC) Information
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Information for Pharmacists - SMAC Program
NYRx pharmacy providers can request for a SMAC price review. Pharmacy providers may submit a SMAC Price Research Request form located below along with a copy of the invoice listing the current acquisition cost for the product(s) in question to Prime Therapeutics State Government Solutions via fax (888-656-1951) or email (StateMACProgram@primetherapeutics.com). SMAC Price Research Requests are only warranted if the basis of reimbursement is SMAC. For more information, refer to NYRx Pharmacy Reminder: SMAC Price Research Requests and NYRx Reimbursement.
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| New York Medicaid SMAC Updates List - Posted 5/15/2025 |
| New York Medicaid SMAC Price Research Request Form |
The New York Medicaid SMAC prices are occasionally overridden by other factors in the New York Medicaid reimbursement algorithm. Current prices for all covered NDCs can be found at the New York Formulary File website.