NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14.
The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:
- Reimbursement can be made for both participating and non-participating Medicaid Providers during the three-month retro period up until they submit the application.
- Reimbursement can be made for only Medicaid participating Providers from the date the application is submitted up until they receive the Common Benefit Identification Card (CBIC).
- Reimbursement can be made for both participating and non-participating Medicaid Providers due to agency error or delay.
If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov.
On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor’s desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.