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.
Information of interest to pharmacists and prescribers is organized within the following topic areas:
Drug and Supplies Coverage
Coverage spans topics from formulary to diabetic supplies. Select Drug Coverage for further information and documents.
Emergency Services
Emergency Services, in its current form, began as Medicaid Redesign Team Project #3 "..." .... Select Emergency Services for further information and documents.
Oversight and Guidance
Oversight and guidance includes many aspects of the Pharmacy Program. Drug Utilization Review (DUR), Mandator Generic Program, Opioid Management and the Pharmacy Therapeutic Commitee to name a few. Select Oversight and Guidance for further information and documents.
Professions and Roles
Prescribers, Pharmacists and Pharmacists as immunizers are only a fraction of the professions and roles that are impacted by the Medicaid pPharmacy Program. Select Professions and Roles for further information and documents.
Related Programs and Information
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 which is a monthly publication by the Office of Health Insurance Programs.
Links outside the Department:
