Drugs Covered by NYS Medicaid for Dual Eligible Members Effective 10/22/2020

Prescription Drugs

The New York State (NYS) Medicaid program provides prescription drug coverage only for the drugs listed below for members who are also enrolled in a Medicare Part D drug plan and Medicare Advantage Drug Contracting (MAPD) plans. All other prescription medications should be reimbursed through the Part D plan. For the most up to date coverage information for the products below, providers should refer to the NYS Medicaid List of Reimbursable Drugs available at: https://www.emedny.org/info/fullform.pdf.

Prescription Drugs covered for dual eligible beneficiaries:

  • Vitamins
    • Folic acid - oral
    • Hydroxocobalamin - injection
    • Vitamin B12 - injection/nasal
    • Vitamin D2 - oral
    • Vitamin K - oral
  • Cough and Cold
    • Benzonatate

NYS Medicaid does not provide dual eligible members with coverage of compounded prescriptions.

The links below provide more information on drug coverage under Medicare Part B and D:

Over-the-Counter Drugs

NYS Medicaid covers over-the-counter (OTC) products for members with a prescription or fiscal order. For a list of OTC drugs that are covered, providers can refer to https://www.emedny.org/info/fullform.pdf then look for "Rx Type 07" toward the end of the document.

NYS Medicaid also covers certain OTC drugs for dual eligible members, if coverage is not available under Medicare. Only Medicaid reimbursable drugs excluded by Medicare law are covered for dual eligible members. Therefore, Medicaid does not cover OTC insulin and some OTC products which have legend drug substitutes that are covered by Medicare Part D and MAPD plans.