On April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs Plans (SNPs) began receiving pharmacy benefits from NYRx, the pharmacy program under Medicaid Fee-For-Service (FFS).

The pharmacy benefit transition WAS NOT applied to members enrolled in Managed Long-Term Care plans (e.g., PACE, MAP, and MLTC), the Essential Plan or Child Health Plus, and it did not change the scope of benefits (e.g., copayments and covered drugs) of the existing Medicaid Pharmacy Benefit.

DOH posted Information for Pharmacies Submitting Medicaid 340B Drug Claims: Click here for the full pdf.

More information on the transition to Medicaid FFS under the NYRx program is available for Providers, Prescribers and Pharmacists on the Department of Health’s website.

Should you need anything else on this topic, please feel free to reach out to attorney Matthew Babcock at mbabcock@harrisbeach.com to discuss an engagement.