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’ Mike Sargent at 207-272-6435.

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’ Mike Sargent at 207-272-6435.

The State Department of Health shared the following reminder:  

NYRx, the Medicaid Pharmacy Program would like to remind stakeholders, including prescribers, pharmacists, members and other caregivers, that 90-day supplies of most maintenance medications and over the counter (OTC) drugs are covered by NYRx. This benefit applies, but is not limited to, NYRx covered OTC medications such as aspirin, acetaminophen, ibuprofen, antihistamines and covered vitamins and minerals, such as prenatal vitamins, vitamin B, vitamin D, calcium, fluoride and iron preparations. For a complete list of medications covered by NYRx, see the Medicaid pharmacy list of reimbursable drugs. 90-day supplies offer numerous benefits:  

• For patients, cost savings with less copays, convenience of less trips to the pharmacy, improved medication adherence and reduced risk of missing refills. 

• For prescribers, increased patient adherence equals easier monitoring, reduced administrative burden, increased patient satisfaction and a more streamlined process for chronic disease management. 

• For pharmacies, increased patient adherence, improved operational efficiency leading to more time for additional services such as immunizations and medication therapy management (MTM) and enhanced customer satisfaction resulting in a stronger patient-pharmacy relationship. 

Prescribers should consider writing for a 90-day supply and pharmacists should work with prescribers to switch to a 90-day supply, once it is determined the patient is on a stable dose of a maintenance medication or OTC drug.  

Furthermore, pharmacists may also submit for package size quantities that closely represent the prescriber's fiscal order. For instance, if a prescriber writes for a quantity of 90 tablets and the closest package size is 100 tablets, that can be utilized. 

For questions on this policy, contact NYRx@health.ny.gov or 518-486-3209. 

Also in New York, NYRx Education and Outreach team shared an NYRx Brand Less Than Generic Program Update, effective August 21. 

• Complera® will be ADDED to the program. 

• Pradaxa®, Sandostatin LAR®, and Sprycel® will be REMOVED from the program. 

For more information related to the Brand Less Than Generic (BLTG) Program, please review the BLTG YouTube webinar, NYRx, the Brand Less Than Generic (BLTG) Program – YouTube.

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

The Office of Health Insurance Programs of the State Department of Health has approved the release of the June 2025 Medicaid Update. The current issue’s table of contents includes the following:

All Providers

• New York State Recipient Restriction Program and Health Home Care Management Program Services (Cover)
• New York State Department of Health Announces New Advisory Boards: Medicaid Advisory Committee and Beneficiary Advisory Council
• Notification of Pregnancy to Medicaid Managed Care Plans
• New York State Office of the Medicaid Inspector General to Perform Compliance Program Reviews Using a 12-Month Review Period

Policy and Billing

• Payment Error Rate Measurement Upcoming Request for New York State Medicaid Provider Documentation
• Update and Reminder: Medicaid Policy on Loss of Records Due to Unforeseen Events

Pharmacy

• Notice for Upcoming Over-the-Counter Coverage Changes
• Attention Providers: Disclosure of Ownership and Control Information

Also in New York, the July Department of Health (DOH) Pharmacy Association meeting shared the updated form for NYRx, the New York State Medicaid Pharmacy Program Coordination of Benefits: Non-Preferred Diabetic Supplies, as discussed in the July Department of Health (DOH), Office of Health Insurance Programs (OHIP) and Pharmacy Associations meeting. The update is also located on the DOH website in the Medical Supplies section under Preferred Diabetic Supply Program (PDSP).

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

On July 16, the State Department of Health hosted its monthly pharmacy community meeting for NYRx, the state Medicaid pharmacy benefit program. NYRx also offers a monthly newsletter that contains helpful updates and links. The call focused on two topics. First, an update on diabetic testing supplies – advising pharmacies to become familiar with the preferred supply list. Second, a reminder to update the ETIN (Electronic Transmitter Identification Number), if needed, and how to do so. 

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

Effective July 15, NYRx, the Medicaid Pharmacy Program, will accept electronic prior authorization (ePA) requests via CoverMyMeds® in addition to the current phone and fax submission methods. 

To learn more about CoverMyMeds® Electronic Prior Authorization for Medicaid Prescribers, please attend one of the webinars which occur on Tuesdays and Thursdays from 12:00 pm – 1:00 pm ET. View the calendar with upcoming dates and registration links. 

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.  

In addition, the following changes will be made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program:  

"NuvaRing® will be REMOVED from the program, as the new manufacturer of NuvaRing® does not participate in the Medicaid Drug Rebate Program (MDRP)." 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. 

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

The State Department of Health announced that effective July 1, several drug manufacturers voluntarily withdrew from participation in the Medicaid Drug Rebate Program (MDRP). The Centers for Medicare and Medicaid Services (CMS), in compliance with Social Security Law Sec. 1927 [42 U.S.C. 1396r–8] (a), requires drug manufacturers to participate in the MDRP for their drugs to be eligible for coverage under the Medicaid program. Prescribers and pharmacies are encouraged to assist members with a therapeutically equivalent generic or to obtain a new prescription for an available alternative. 

Also in New York, the Board of Pharmacy met on June 26. The agenda included a presentation by the Department of Health's Bureau of Narcotic Enforcement and a discussion of prescription transfers, shared pharmacy services regulations, Legislative matters and board meeting dates/locations. 

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

On June 11, the New York Register published a Notice of Adoption by the Workers’ Compensation Board related to Network Pharmacies. The adopted rule provides guidance about when injured workers can obtain prescribed medication outside of the network. It takes effect on July 11.

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

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.