NYRx, the New York Medicaid Prescription Drug Program, made the following changes to the preferred drug list. Effective February 7, the following changes will be made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program: 

1. Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program.
2. Flovent® HFA and Pennsaid® pump will be REMOVED from the program. Note: Pennsaid® pump has been discontinued by the manufacturer.
3. Diclofenac 2% topical solution will remain in non-preferred status on the NYRx Preferred Drug List. Prescribers should transition their patients to an alternative preferred product or obtain a prior authorization for the diclofenac 2% solution. 

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: 

1. Do not require “Dispense as Written” (DAW) or “Brand Medically Necessary” on the prescription.
2. Have a generic copayment.
3. Are paid at the Brand Name Drug reimbursement rate or usual and customary price, whichever is lower (SMAC/FUL are not applied).
4. Do not require a new prescription if the drug is removed from this program. 

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

NYRx, the Medicaid Pharmacy Benefit Program, updated the preferred drug list, impacting Albuterol HFA formulations. The following are preferred in the NYRx Preferred Drug Program: 

• albuterol HFA – generic ProAir® HFA (8.5 grams) 
• albuterol HFA – generic Proventil® HFA (6.7 grams) 
• Proventil® HFA 
• Ventolin® HFA BLTG (Ventolin® HFA is subject to the Brand-Less-Than-Generic Program. The generic formulation of Ventolin® HFA, albuterol HFA (18 grams), is non-preferred and will require prior authorization.) 

Effective February 7, NYRx will make the following changes to the Brand Name Drug When Less Expensive Than the Generic Program: 

• Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program. 
• Flovent® HFA and Pennsaid® pump will be REMOVED from the program. 

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

On January 16, Gov. Kathy Hochul (D) announced her current year budget proposal. The impactful sections are below:   

1. Streamline Medicaid Drug Cap – to streamline and remove prior triggers to enable the state to get manufacturer rebates more quickly 
2. Discontinue Prescriber Prevails – to eliminate prescriber prevails in Medicaid where clinical standards for approval are not met 
3. Pharmacy Enhancements and Integration Specialty Drug Management – to create new benchmarks for physician administered drug reimbursement similar to pharmacy reimbursement under Medicaid Fee-for-Service (FFS); part of the goal is to bring drugs that do not have a NADAC up to WAC instead of current WAC-3%. Also, it includes requirement for all Medicaid enrolled pharmacies to submit annual cost reports in a form requested by the state Department of Health (DOH).  
4. Reduce Coverage for Over-The-Counter (OTC) Pharmaceuticals – to enable DOH to modify the list of OTCs covered in the Medicaid program  

Also in New York, NYRx, the New York Medicaid Pharmacy Benefit Program, held its regular industry call on January 17. Updates are below; however, two other conversations occurred during the call, including Pharmacy Cost Reporting proposed in the budget and Inspector General (OMIG) audit protocols regularly updated to reflect Medicaid FFS pharmacy policies, e.g., change in signature on deliveries requirement. OMIG will be joining the February Pharmacy Sector call. 

1. Covid-19 Oral Antivirals: DOH discussed new guidance related to billing for antivirals (Paxlovid™ and Lagevrio™). 
2. Covid-19 Vaccine Billing for non-VFC (Vaccines for Children) Pharmacies: DOH discussed guidance for billing non VFC and admin code to use for VFC and non-VFC which can be found here. 
3. 1115 Waiver: 3-year waiver approved totaling $7.5 billion through March 31, 2027.  

NYRx also revised its preferred drug list, effective January 18.  

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

NYRx, the New York Medicaid Pharmacy Benefit Program, issued this update regarding the NYRx BLTG (Brand Less Than Generic) Program for Flovent® and Advair®.  

Also in New York, the Board of Pharmacy sent out two updates on January 2:  

• The online Discontinuance Form discussed at the regular November meeting is now accessible to the public. Directions and further information regarding the online Discontinuance Form can be found online.  
• The Board has finalized and posted the new Drug Retail Price list online.  

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

NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14. 

The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:  

• Reimbursement can be made for both participating and non-participating Medicaid Providers during the three-month retro period up until they submit the application. 
• Reimbursement can be made for only Medicaid participating Providers from the date the application is submitted up until they receive the Common Benefit Identification Card (CBIC). 
• Reimbursement can be made for both participating and non-participating Medicaid Providers due to agency error or delay. 

If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov. 

On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor’s desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation. 

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

Effective November 29, the New York Department of Health issued updated guidance regarding dispensing of COVID-19 over-the-counter tests at the pharmacy.

NYRx, the New York State Medicaid Pharmacy Benefit Program, sent a release to pharmacy providers on December 6^th. The program continues to field questions and concerns from residency program coordinators about pharmacies not able to submit claims to NYRx written by their interns and residents. NYRx asked the following shared regarding submission of claims:

1. Provider Manuals (emedny.org)
2. Provider Manuals – Pharmacy Manual (emedny.org)
3. pdf (emedny.org)
4. NYRx, the Medicaid Pharmacy Program | Education & Outreach (fhsc.com)

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

On November 14, NYSDOH (New York State Department of Health) hosted its monthly NYRx industry call regarding the Medicaid Fee for Service program. Following agenda items were discussed: 

• RSV (Respiratory Syncytial Virus) vaccination update: Discussion on recent statewide standard orders from NYSDOH including the most recently issued order for pharmacists to give RSV to pregnant individuals. These resources and others can be found at a dedicated RSV page on NYSDOH’s website. 
• PrEP (Pre exposure Prophylaxis) testing by pharmacies: Request was made for NYSDOH to partner in enabling pharmacies to provide such testing through needed statutory changes/authorizations. 
• Pharmacy billing guidance for new generic launches: NYSDOH walked through its process to add generic coverage once a generic becomes available and after that move certain brands to this program. 
• Refill period: Request made to expand refill period similar to MMC for over the counter (OTC) products (11 refills). NYSDOH discussed their policy and processes in response. 
• Reminder of Pharmacists as Immunizers 
• Office of Medicaid Inspector General (OMIG) update: presentation on NYS OMIG’s Recipient Restriction Program and how pharmacies can fill their prescriptions including a number of limitations and additional requirements. Prescriptions cannot be transferred to other pharmacies under the program.  

NYRx also published billing guidance for brand name drugs with new generic launces.  

On November 15, the formal printing of the withdrawal of the PBM regulations by the Department of Financial Services was published. Within the publication are: 

• Notice of Withdrawal of Rule on Definitions, Licensing of PBMs, Contracting with Network Pharmacies, Acquisition of PBMs, Consumer Protections, and Audits; and 
• Notice of Adoption regarding Pharmacy Benefits Bureau; Pharmacy Benefit Manager Assessments; Filings and Other Requirements for Issuance 

The New York State Board of Pharmacy held its regular meeting on November 8. Relevant to chain pharmacies, the meeting included the following: 

• During the Report of the Chair: referenced the State Plan Amendment was approved in August related to Medicaid reimbursement for pharmacist authorized services within their scope, claims to be paid to pharmacies. 

• During the Report of the Executive Secretary: Central Fill regulations will not be pursued based on comments received and instead plan to address within the broader context of Shared Services. The Long Acting Injectables bill is pending the Governor’s action, plus new self-administered contraceptives in pharmacy law takes effect in 2024. 
• Discussion on Pharmacy Workplace Issues: The Board discussed the USA Today article on recent events with pharmacy workplace issues/walkouts. The Board discussed how to promote the profession to youth/students to encourage them to go into the profession given enrollment declines, shortages, and related challenges. The Executive Secretary reported receiving requests that the Board should take up regulations to address this like regulating quotas, but noted its regulations follow statutory changes providing authority, which has not happened. One member of the board noted receiving feedback that there are pharmacist shortages, so pharmacies are being forced to close causing access issues.  

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

On November 1st, the New York Department of Financial Services pulled back on regulations regarding PBMs (Pharmacy Benefit Manager). This was in response to an “overwhelming” number of comments submitted in opposition to the regulation from unions, employers, and health plans. The legislative objectives driving the regulations were ‘licensing standards for PBMs, including minimum standards related to market conduct practices, conflicts of interest, deceptive, anti-competitive, and unfair claims practices in connection with the performance of pharmacy benefit management services, predatory audit practices, and actions or procedures in the PBM industry that go against the best interests of the public.’  While the full regulations were pulled back, the Department did move part of the rule-making process and fully adopted the registration requirement for PBMs.  

On November 8th, the New York State Board of Pharmacy will be holding their regular scheduled meeting in person in Albany. The agenda is as follows:  

Executive Session 9:30 a.m. 

• Proprietary matters relating to licensing exam development, administration, and assessment. 
• Disciplinary and Professional Assistance Program discussions that address confidential processes, investigations, and prosecutions. 

Public Session 1:00 p.m. 

• Welcome and Introduction 
• Review and approval of June meeting minutes 
• Report of the Chair 
• Report of the Executive Secretary
• NABP (National Association of Boards of Pharmacy) Presentation: Drug Supply Chain Security Act 
• Report: Jurisprudence Committee
• New business 

o Discussion: Online Discontinuance Form 

o Discussion: Drug Price List 

o Upcoming 2024 Meeting Dates 

• Closing remarks and adjournment 

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

Medicaid posted a COVID-19 vaccine billing guidance for this season. The Medicaid “Pharmacists as Immunizers Fact Sheet” has information on how to bill for vaccines for over and under 19 years of age and a link to the Vaccine for Children (VFC) Program. Please be advised that Medicaid does reimburse for the COVID-19 vaccine and administration at Medicaid qualified pharmacies for adults 19 years of age and older. Children under the age of 19 years are vaccinated for COVID-19 and all other ACIP–recommended vaccines at VFC enrolled providers, including their practitioner’s office, public health clinics or, in most areas, their county health department. At this time, pharmacies dually enrolled in Medicaid and VFC may also immunize children between the ages of 3 to under 19 years of age for COVID-19, and ages of 2 to under 19 years for influenza, in accordance with the federal PREP (Public Readiness and Emergency Preparedness) Act and/or state law.

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