NYRx, the Medicaid Pharmacy Benefit Program, announced updates to the Preferred Drug List. These changes were effective May 29. 

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

On May 21, the Senate Committee on Higher Education reported favorably S9186, a bill to update shared pharmacy services. The bill will establish conditions under which resident or non-resident pharmacists and pharmacies may participate in shared pharmacy services. S9186 has previously passed the Assembly. NACDS will continue to advocate for final passage of the bill in the Senate.

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

On May 15, 2024, the State Department of Health held its monthly NYRx, the Medicaid pharmacy benefit program, call for stakeholders in the pharmacy community. The agenda included a wrap up of the state budget, update to over-the-counter COVID-19 testing and pharmacy claims edit.  

On May 15, 2024, A9729, a bill related to shared pharmacy services, was approved by the Assembly. Under the bill, "shared pharmacy services" means a system that allows a registered pharmacist or a registered pharmacy, pursuant to a request from another registered pharmacist or pharmacy to process or fill a prescription or order, pursuant to regulations promulgated by the Commissioner of Education. The bill now moves to the Senate where we expect action. NACDS will continue to advocate for the bill's passage.

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

On April 17, 2024, NYRx, the New York State Medicaid Pharmacy Benefit Program, held its monthly call for pharmacy providers. On the agenda were long-acting injectable administration, COVID-19 anti-virials, self-administered hormonal contraceptives and Extencilline coverage. Questions and Additional Information: 

• NYRx claim questions should be directed to the eMedNY Call Center at (800) 343-9000. 

• NYRx Pharmacy coverage and policy questions should be directed to the NYS Medicaid Pharmacy Policy Unit by telephone at (518) 486-3209 or by email.  

Billing guidelines for Long-Acting Injectable administration: 

Pharmacies will be reimbursed for the medication and an administration fee when billed to NYRx. The member will not have a copayment for drug administration. 

• NYS legislation requires a patient specific prescription or order for administration. These orders must be kept on file at the pharmacy. 
• If billing for both the drug and administration, these claims must be submitted separately. 
• For the drug, the claim must be submitted using the ordering prescriber's NPI in the Prescriber ID field. The pharmacy will be reimbursed for the medication when billed via National Drug Code (NDC) using reimbursement methodology. For the administration, the claim must be submitted using procedure code 96372, and the pharmacy's NPI in the Prescriber ID field. A pharmacy will be reimbursed the administration fee of $13.36. 

New York State Medicaid has also notified pharmacies that in response to the ending of the COVID-19 public health emergency on May 11, 2023, effective May 13, 2024, a fiscal order is not required for the first two tests per month. Furthermore, pharmacy reimbursement and covered products available on the pharmacy formulary will be modified. Additional tests may be covered with a fiscal order, when medically necessary. Coverage will be provided for OTC FDA-authorized COVID-19 test kits used in accordance with the Centers for Disease Control and Prevention (CDC) recommendations for antigen detection. This policy for coverage of at-home test kits via NYRx, the NYS Medicaid Pharmacy Program, will remain in effect until further notice. 

If a member needs more than two (2) tests per month, and all other resources were utilized, and the member has a fiscal order, the pharmacy may call the Pharmacy Policy unit at 518-486-3209 for a review of medical necessity. 

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

The State Medicaid Pharmacy Benefit Program, NYRx, issued guidance for billing of long acting injectables for mental health and substance abuse treatment.

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

On March 27, the State Department of Secondary Education published the following emergency orders in the New York Register (March 27, 2024, Vol XLVI, Issue 13).  

• Pharmacist Dispensing Self-Administered Hormonal Contraceptives which was effective March 12, 2024, and 
• Administration of Injectable Medications by Pharmacists for the Treatment of Mental Health and Substance Use Disorder, effective April 1, 2024. 

Also in New York, the State Department of Health also issued a billing guidance on issuance of hormonal contraceptives. For NYRx billing, see below:  

• To bill for the self-administered hormonal contraception, the pharmacy must submit a valid National Drug Code (NDC). Pharmacies must bill the Usual and Customary (U&C) price and will be reimbursed according to NYRx payment methodology and a $10.18 dispensing fee.
• To bill for the evaluation and management associated with the ordering of self- administered hormonal contraception, pharmacies will submit using the National Council for Prescription Drug Programs (NCPDP) D.0 claim format and enter one of the Healthcare Common Procedure Coding System (HCPCS) codes identified below. 
• NYRx members may receive up to 12 months of prescription contraceptives at one time for family planning purposes as authorized by the Title 18 NYCRR Section 505.3(e). 
• Pharmacies are expected to dispense up to the quantity limit of the prescription or Standing Order, one year supply, at the time of dispensing, pursuant to patient preference or primary insurance coverage limitations.
• Submitting any assessment code more than once a year requires cause.

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

On March 19, the State Department of Health Commissioner signed a standing order regarding the new law authorizing pharmacist dispensing of hormonal contraception. The standing order signed by the State Health Commissioner pertains to three types of self-administered hormonal contraceptives that are approved by the federal Food and Drug Administration to prevent pregnancy, which include the following:  

• Oral hormonal pill  
• Hormonal vaginal ring  
• Hormonal contraceptive patch  

Pharmacists who choose to participate can dispense up to 12 months of a self-administered hormonal contraception of the individual's preference and covered under insurance. 

Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the February 2024 Medicaid Update. The update includes:  

Pharmacy: 

• Reminder: Pharmacies Submitting Medicaid 340B Drug Claims (Cover)  
• Reminder: Pharmacy Coverage Includes Over the Counter Naloxone 

Policy and Billing: 

• Update for Long-Term Care Pharmacy Providers on Short Cycle Billing of Pharmacy Claims 

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

On March 5th, the NYRx Clinical Call Center reported that they are experiencing higher than normal call and fax volume. Prescribers should not send duplicate prior authorization (PA) requests to NYRx. Prescribers may experience a higher volume of requests for PA, but only one submission is necessary. Pharmacies should only request one PA for each member for each drug. Duplicate requests slow down the processing time at the NYRx Clinical Call Center. For more information, refer to NYRx Notice to Providers: Duplicate Prior Authorization Requests. To review how to submit a PA to NYRx, refer to the NYRx Prior Authorization Submission Guide. 

Enhancements have been made to the NYRx clinical criteria system editing. The clinical criteria have not changed and should be reviewed on the NYRx Preferred Drug List prior to obtaining a PA. Preferred products should be prescribed when clinically appropriate. In most cases, preferred products will not require a PA when prescribed according to FDA (FOOD AND DRUG ADMINISTRATION) labeling. To review NYRx preferred products only, refer to the NYRx Preferred Drug Quick List. 

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

On February 27, the State Department of Health Office of Health Insurance Programs approved the release of the January 2024 Medicaid Update.  

• eConsults (Cover) 
• NY State of Health Public Health Emergency Unwind Fact Sheet for Providers Now Available 

• Zynteglo® (betibeglogene autotemcel): Medicaid Practitioner Administered Drugs Update 
• Reminder: New York State Medicaid Covers Nirsevimab, Abrysvo and Arexvy for the Prevention of Respiratory Syncytial Virus 
• Updated Fees for Family Planning Services 
• Medicaid Managed Long Term Care Transportation Carve Out Begins March 1, 2024 

Also in New York, the State Board of Pharmacy will be holding its regular meeting on March 7 at 10:00 am in New York City. The Board advises that members of the public wishing to observe the Board of Pharmacy's public session must email their full name to the Pharmacy Board office (pharmbd@nysed.gov) at least 48 hours in advance. Failure to notify the Board office may result in delayed entry to the meeting. For security purposes, a valid Government issued ID will be required for admittance. 

Also in New York, S8545, was introduced last week at the request of NACDS and the Community Pharmacy Association of New York State. This legislation would (1) remove the limitation on where "registered pharmacy technicians" can practice in the state to all pharmacy settings; (2) add vaccine administration authority to the duties of registered pharmacy technicians; and (3) provide greater flexibility in the supervision standard for pharmacists overseeing registered pharmacy technicians from a "direct personal supervision" standard to being immediately available. An Assembly companion bill will be introduced soon.  

Also in New York, on February 13, the State Department of Health issued a new non-patient specific prescription for naloxone with pharmacy dispensing protocol effective February 13, 2024, through February 12, 2026.  

Finally in New York, the State has expanded its existing efforts at monitoring and understanding prescription drug prices by enacting legislation addressing prescription drug price transparency. Effective June 19, 2024, S599-A/A1707 amends the New York Insurance Law to require prescription drug manufacturers to report certain price increases before they occur. 

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