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:

  • Emergency Services Only Pharmacy Coverage (Web) - (PDF) - 6.9.20
  • Information on Medicaid Pharmacy MRTs (Web)
  • Pharmacists as Immunizers
    • NYS Medicaid Program Pharmacists As Immunizers Fact Sheet (Web) - (PDF) - September 2019
  • Medicaid Program - Dispense Brand Drugs When Less Expensive (Web)
    • Dispense Brand Name Drugs When Less Expensive Initiative (PDF)
  • Medicaid Pharmacy Reimbursement Methodology (PDF)
    • Archived Information Regarding Average Acquisition Cost (AAC)/Cost of Dispensing (COD)Cost of Dispensing (Web)
  • Medicaid List of Reimbursable Drugs (Formulary File) (Web)
  • Medicaid Mandatory Generic Drug Program (Web)
  • The New York State Medicaid Mandatory Generic Clinical Exemption Request Form (PDF)
  • Medicaid Pharmacy Preferred Drug Program (Web)
    • Medicaid Preferred Drug Program Annual Reports to the Governor and Legislature (Web)
  • Medicaid Preferred Diabetic Supply Program (Web)
  • Medicaid Clinical Drug Review Program (Web)
  • Medicaid Pharmacy and Therapeutics Committee (Web)
  • Medicaid Drug Utilization Review Program (DUR) (Web)
    • Opioid Management (Web)
    • Electronic Mailing Lists (Web)
  • Medicaid Medication Therapy Management Pilot Program (Web)
  • Medicaid Prescriber Education Program (Web)
  • Medicaid and the Medicare Part D Prescription Drug Benefit (Web)
  • Medicaid Child (Foster) Care Drug Carve-out List (Web)
  • Medicaid Drug Rebate Program
    • Generic Drug CPI Initiative
  • Practitioner Adminstered Drug Policies and Billing Guidance (Web)
  • Pharmacy Provider Communications (Web)
  • Medicaid Update - A monthly publication of the New York State Department of Health, Office of Medicaid Management (Web)
  • FDA Press Announcements (Web)
  • FDA Medical Product Safety Information (Web)