On February 21, NYRx, the New York State Medicaid Pharmacy Benefit Program, held its monthly pharmacy sector meeting. On the agenda were the following:  

  1. AIDS Institute – HCV (hepatitis C virus) drugs & test to treat model. 
    1. DOH (Department of Health) asked the following of pharmacies: 
      1. Does your pharmacy stock hepatitis C medications? How long does it take to get in stock? 
      2. How can we get medications in the client’s hands more quickly? 
      3. How can providers build collaborations with their local pharmacies to ensure timely access to hepatitis C medications? 
      4. How have you worked with hepatitis C providers in your community? 
      5. Feedback can be shared with Colleen Flanigan (colleen.flanigan@health.ny.gov) 
  1. OMIG (Office of the Medicaid Inspector General) Pharmacy Audit Protocols. 
    1. OMIG utilizes a stakeholder process for updated regulations that includes feedback from DOH and professional associations. OMIG reviews and considers all comments that are submitted before issuing a revised protocol set.  
    2. Bill Schwarz with OMIG added that updated protocols are in development. Feedback may be shared at information@omig.ny.gov. 
  1. Bureau of Medical Review – Incontinence Supplies. 
    1. Incontinence products claims have doubled since 2019 and require a valid diagnosis code that directly relates to incontinence for reimbursement. 
    2. Incontinence products info can be found in the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Procedure Manual. 
    3. Starting in April, the DME (Durable Medical Equipment) Procedure Manual will be updated with a separate pharmacy manual. DMPOS Procedure Manual will contain everything that Managed Care Plans are still responsible for.  
    4. Questions: OHIPMedPA@health.ny.gov (1-800-342-3005) 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.