NYRx released an updated Pharmacy Vaccine Billing Guidance, with new fees effective October 24.

Also in New York, on October 16, the State Department of Health hosted its monthly NYRx Pharmacy call. The agenda items included:

  1. OMIG Restricted Recipient Program: Requirements for primary care providers and pharmacies for patients in this program including new edits taking effect in November 2024 and February 2025, and billing and referral instructions.
  2. Reimbursement Changes under NYRx: Effective October 1, paying WAC for brand drugs that lack a NADAC (was WAC-3%)
  3. III. New Guidance Allowing 90-Day Prescriptions and 90-Day Prescribing under NYRx
  4. NYRx Coverage of OTC Progesterone-Only Contraception: With Opill available, NYRx reminder that they will only cover it for those with Medicaid if they obtain it from a pharmacist who is authorized to dispensing hormonal contraception per new law/ standing order and following patient questionnaire/counseling etc. or with a fiscal order from their prescriber.
  5. NYRx Compound Policy
  6. Prior Authorizations: Slides include clarification on NYRx prior authorization policies per a request for guidance.

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