NYRx, the State Medicaid Pharmacy Benefit Program, announced effective June 12, the following changes were made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program:
- Anoro Ellipta®, Motegrity® and Promacta® tablets were be ADDED to the program.
- Glumetza® and Xopenex HFA® were removed from the program. Glumetza® is being removed as it has been discontinued by the manufacturer.
In conformance with State Education Law, a pharmacist shall dispense a less expensive, therapeutically equivalent drug containing the same active ingredients, dosage form and strength as the drug prescribed/ordered. This includes substituting the brand name drug when NYRx has determined it to be the less expensive alternative for the patient. Brand name drugs included in this program:
- Do not require "Dispense as Written" (DAW) or "Brand Medically Necessary" on the prescription.
- Have a generic copayment.
- Are paid at the Brand Name Drug reimbursement rate or usual and customary price, whichever is lower (SMAC/FUL are not applied).
- Do not require a new prescription if the drug is removed from this program.
The NYRx Education & Outreach Call Center is available by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 am to 5:00 pm Eastern, Monday through Friday, excluding holidays.
The NYRx Education & Outreach team hosts virtual office hours every week for stakeholders to ask questions related to NYRx and care coordination. Visit the NYRx Education & Outreach website for more information.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.