NYRx, the Medicaid Pharmacy Program

Maximum Allowable Cost (MAC) Information

Electronic PA Requests

Electronic prior authorizations are now accepted by NYRx, the Medicaid Pharmacy Program via CoverMyMeds®. Consider this alternative option as an effective and efficient way to request a PA other than by phone or by fax. For more information, contact NYRx Education & Outreach at 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 7/17/2025
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.