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’ Mike Sargent at 207-272-6435.

A678/S3236, legislation that allows pharmacy technicians to practice in any pharmacy under the supervision of a pharmacist, has been passed by both chambers. The bill now moves to the Governor for signing. NACDS and the Community Pharmacy Association of New York have advocated for this bill all session, having directly lobbied both chambers and the administration.  

Also in New York, the State Department of Health held its monthly pharmacy call to discuss NYRx, the New York state Medicaid pharmacy benefit program. The agenda included two items: a change in covered diabetic supplies (see below) and a reminder that electronic prior authorizations will start this summer through CoverMyMeds.  

• As a reminder, NYS Medicaid is the payor of last resort and providers are required to bill all applicable third-party payors before Medicaid. For additional information about the coordination of benefits, refer to NYRx Third Party Liability and Coordination of Benefits.  

• If a member cannot switch from a LifeScan product to a Preferred Diabetic Supply, the pharmacy can request a review of the claim for payment by NYRx by following the steps outlined below. Consideration will be made if there are formulary limitations with the primary payor and it is not possible to switch the member to a preferred product.  

• The pharmacy provider may fill out this form and submit it to eMedNY Claims Processing for review. Responses will be faxed back to the pharmacy within three business days. Providers may also call the eMedNY Call Center at 1-800-343-9000 to request a review of the claim.  

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.