Medicaid Pharmacy Program

The New York State Medicaid Pharmacy program covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid fee-for-service enrollees. Enrollees in mainstream Medicaid Managed Care and Family Health Plus plans receive pharmacy benefits directly through the managed care plans. Prescription drugs require a prescription order with appropriate required information. Non-prescription drugs, often referred to as Over-the-Counter or OTC drugs, require a fiscal order (a fiscal order contains all the same information contained on a prescription). Certain drugs/drug categories require the prescribers to obtain prior authorization.

Pharmacy program and billing policy and other pharmacy related information can be found in the NYS MMIS Pharmacy Provider Manual and the Department's Medicaid Update. You may also contact us at PPNO@health.ny.gov or (518) 486-3209 for Medicaid pharmacy policy related questions.

For more information and copies of letters sent to pharmacists and prescribers, please see Pharmacy Provider Communications below.

The following information may be of interest to pharmacists and prescribers:

Pharmacy Program Information

Related Programs and Information