On January 17, from 1:00 p.m. – 3:00 pm, the Department of Health (DOH) is hosting the next in its series of monthly stakeholder informational webinars about the transition of the pharmacy benefit from Medicaid Managed Care to Medicaid Fee for Service (NYRx). Registration is required in order to access the meeting links. Presentations from past meetings are available on the transition website. 

Also in New York, the DOH issued an update to the Medicaid Fee for Service Program “Dispense Brand Name Drug When Less Expensive Than Generic” list effective January 19. Additionally, DOH published an updated standing order for Naloxone under the signature of Dr. Sharon Stancliff. 

Finally in New York, as 2022 ended, Gov. Kathy Hochul (D) signed several bills important to pharmacy practice into law, including: 

• S4870B authorizing pharmacists to administer certain long acting injectables (Note: rules will need to be promulgated and a new bill for 2023 with minor technical changes to the law has been agreed to.) 
• A7469 allows for 30-day emergency refills 
• A187 permits pro-rated cost sharing on short fills and maintains the full dispensing fee to enable medication synchronization in the state’s Medicaid program 

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

Gov. Kathy Hochul (D) has vetoed A7889, a bill meant to reform the Medicaid audit process. In her veto message, the Governor cited concerns about the bill preventing Medicaid from recovering legitimate overpayments and any corresponding impact on the loss of federal funds.  

Also in New York, on December 20, the State Department of Health is hosting an informational online seminar for all stakeholders about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, (Medicaid fee-for-service (FFS) pharmacy program). This is part of a series of recurring monthly webinars about this topic. Note that you must complete the registration form to attend. Afterward, a copy of the presentation will be posted on the transition website, where past presentations are available.  

Finally in New York, Medicaid’s newsletter from November includes a section on pharmacy dispensing/prescribing of emergency contraceptives. 

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

The New York State Workers Compensation Board published a final rule requiring that providers be notified when a provider network exists.

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

The Department of Health (DOH) has established a webpage with information and resources for pharmacies regarding the transition of the pharmacy benefit from Managed Care to NYRx. The page will be updated regularly. You can also email the DOH with questions about this issue by putting “pharmacy benefit transition” in the subject line. To sign up for the Medicaid Redesign LISTSERV, please click here. 

Also in New York, the DOH issued changes to the prior authorization process and an updated preferred drug list for the NYRx program, effective November 17, 2022. 

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

NACDS will be attending the annual meeting for the Community Pharmacy Association of New York in Albany on November 15^th. At this meeting, the priorities and strategies for the 2023 legislative session will be reviewed.

Also in New York, our comments, that were reviewed by New York members will be submitted to the Department of Financial Services for the October 31^st deadline. If your company is also submitting your own comment letter, please be sure to place PBM2022-06 in the subject line.

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

On Tuesday, October 18, 2022, the New York State Department of Health (DOH) hosted a public online seminar about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, the Medicaid Fee-For-Service (FFS) pharmacy program. A copy of the presentation is now available. Valuable information and resources for Medicaid members and providers are also available on the DOH pharmacy transition website. Questions about the transition should be directed to NYRx@health.ny.gov. Please include “Pharmacy Benefit Transition” in the subject line.

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

As referenced in the 1% Across the Board (ATB) Medicaid Rate Increase, the New York State Department of Health revised the Medicaid Fee-for-Service (FFS) pharmacy professional dispensing fee to comply with this change. Effective September 22, 2022, the professional dispensing fee will change from $10.08 to $10.18 for covered outpatient drugs, when applicable. This was based on the enacted budget and was effectuated by Centers for Medicare and Medicaid Services (CMS) state plan approval. This does include retroactive adjustments to the dispensing fee back to April 1, 2022. Those adjustments will be processed at a future date, details will be forthcoming.

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

The Medicaid Department updated the Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program. 

Effective 10/6/2022, the following changes will be made to the Dispense Brand Name Drug 

When Less Expensive Than the Generic Program: 

• Daytrana, Nexavar, Pradaxa and Ventolin HFA will be ADDED to the program
• ProAir HFA will be REMOVED from the program.

In conformance with State Education Law, which intends patients receive the lower cost drug 

alternative, 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.

IMPORTANT BILLING INFORMATION 

Pursuant to this program, prescription claims submitted to the Medicaid program do not require the submission of Dispense as Written/Product Selection Code of ‘1’; Pharmacies should submit DAW code 9 (Substitution Allowed by Prescriber but Plan Requests Brand). Pharmacies will receive a NCPDP (National Council for Prescription Drug Programs) reject response of “22” which means missing/invalid DAW code if other DAW codes are submitted. The only exception to this, is DAW code 1 and “Brand Medically Necessary” on the prescription. 

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