Gov. Kathy Hochul (D) recently announced new insurance coverage requirements that took effect on January 1, 2026, including a $100 annual cap on out-of-pocket costs for EpiPens. The law applies to state-regulated commercial insurance policies and contracts that are issued, renewed, modified, altered or amended on or after January 1. Because not all policies renew or change on that date, implementation will occur on a rolling basis throughout the year, with full compliance expected by year-end. The cap does not apply to Medicare, Medicaid or ERISA self-insured plans and applies only after deductibles are met for high-deductible plans. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective November 6, Yeztugo® was covered as a pharmacy benefit by NYRx, the Medicaid Pharmacy Program, in addition to being covered by the Medicaid managed care medical benefit as a Practitioner-Administered Drug (PAD). To prevent pharmacy claim denial, it is important for the pharmacy to submit the claim for both oral and subcutaneous products on the same date of service.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The NYRx Education & Outreach team shared the following update. 

Effective November 6, 2025, Rybelsus 3mg will be subject to the following clinical criteria:   

• Prescriptions will be limited to a duration of 30 days, with no refills.  

• Use for glycemic control will not be covered. System updates will be made to ensure alignment of coverage and criteria. Any claims that do not meet the criteria may be impacted and rejected at the pharmacy. 

Any claims that do not meet criteria may be impacted and reject at the pharmacy. 

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 ET, Monday through Friday, excluding holidays. 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

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

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The NYRx Education & Outreach team at Prime Therapeutics announced the NYRx Education & Outreach Notification Service (NYRxEONS). This is a new and free service that keeps stakeholders informed and updated on news regarding NYRx, the Medicaid Pharmacy Program. To sign up, click here.

Also in New York, on October 22, the State Education Department (NYSED) published in the New York State Register an Emergency Rule Making to change regulations to require pharmacists and pharmacies to transfer a patient’s entire prescription, including all authorized refills, upon request. While published on October 22, the change was effective October 7, 2025, when approved by the State Board of Regents. There is now a 60-day public comment period before a Notice of Adoption is issued by NYSED.

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

On October 7, the State Board of Regents voted to amend paragraph (8) of subdivision (a) of section 63.6 of the Regulations of the Commissioner of Education. This amendment, adopted as an emergency rule and effective immediately, requires pharmacists transferring prescriptions to transfer the entire prescription, including all remaining refills, to the new pharmacy chosen by the patient. As an emergency adoption, the amended regulation is now in effect. A Notice of Emergency Adoption and Proposed Rulemaking will be published in the State Register on October 22 for a 60-day public comment period as required under the State Administrative Procedure Act (SAPA). It is anticipated that the regulation will be presented to the Board of Regents for permanent adoption at its February 2026 meeting. Once adopted, the regulation would become permanently effective on February 25, 2026. 

The state has also provided the following: 

• An advisory notice highlighting key elements of the amendment: https://www.op.nysed.gov/advisory-notice-pharmacists-transferring-prescriptions  

• Updated FAQs on prescription transfers, developed with input from the Board's committee https://www.op.nysed.gov/professions/pharmacist/frequently-asked-questions/prescription-refills and https://www.op.nysed.gov/professions/pharmacist/frequently-asked-questions/transfer-of-prescriptions 

Also in New York, Gov. Kathy Hochul (D) extended the declaration of a disaster in the state of New York due to federal actions related to vaccine access by issuing Executive Order 52. 1 to continue access to COVID-19 vaccine through November 2.  

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

The NYRx, the Medicaid Pharmacy Program, posted the following updates effective October 1:

• NYRx Preferred Diabetic Supply Program Resource
• Preferred Drug Program

Also in New York, the NYRx Education & Outreach team posted NYRx Formulary Update: Xifaxan®. Effective October 1, Salix Pharmaceuticals, the manufacturer of Xifaxan®, discontinued participation in the Medicaid Drug Rebate Program. Xifaxan will no longer be covered by NYRx, the Medicaid Pharmacy Program. Prior authorization will not be available for this medication.

Also in New York, NYRx also provided an NYRx Notice to Prescribers and Pharmacies: tretinoin 0.08% micro gel pump, a non-preferred product. The maximum quantity that can be dispensed for tretinoin 0.08% micro gel pump is 50 grams per 30-day supply. 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 ET, Monday through Friday, excluding holidays.

Also in New York, on September 24, the NY State Education Department (NYSED) proposed the changes for implementation of the Shared Pharmacy Services law passed in 2024 as recently published in the State Register (see pages 12-15). A 60-day public comment period will run until November 23.

Finally in New York, the Office of Health Insurance Programs of the New York State Department of Health has approved the release of the August 2025 Medicaid Update. Relevant topic includes New York State Medicaid Coverage for COVID-19 Vaccinations Administered by Providers.

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

The state's Department of Health updated its Preferred Drug List, effective September 15.  

The NYRx Education and Outreach team shared an update to the NYRx Brand Less Than Generic Program Update effective October 1.  

• Arnuity Ellipta® and Exelon® patches will be ADDED to the program.  

• Apriso®, CellCept® suspension, Retin-A® cream, and Targretin® gel will be REMOVED from the program.  

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

Effective September 1, 2025, NYRx, the state's Medicaid Pharmacy program, announced coverage for the 2025-2026 formulations of the COVID-19 vaccine. Effective September 5, 2025, in accordance with the Executive Order #52 and the guidance issued by the Commissioner of Health, pharmacists are authorized to order patient-specific orders for COVID-19 vaccination for patients aged 3 years and older for off-label usage of COVID-19 vaccine. See Advisory Immunization Notification titled 2025-20206 COVID-19 Guidance for Pharmacists located at https://commerce.health.ny.gov. Enrolled pharmacy providers will be reimbursed for vaccine cost and administration when administered to eligible members. Pharmacies will bill NYRx using the National Council on Prescription Drug Programs (NCPDP) D.0 format.  

The Department has since then issued an update on non-patient specific standing order for the administration of the Pfizer-BioNTech updated COVID-19 vaccine (2024-2025 Formula) for persons 5 years of age and older by pharmacists. 

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

On August 21, NYRx, the New York State Medicaid Prescription Drug Program, announced an update to its Preferred Drug Program (PDP).

Also in New York, the State Department of Health Office of Health Insurance Programs released a Medicaid update. This update includes a reminder of 90-day prescriptions for most maintenance medications and OTC drugs. The update also includes a notice that NYRx now accepts electronic prior authorizations through CoverMyMeds.

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