For Medicaid Consumers

What You Need to Know About Getting Your Prescription Drugs through Medicaid

Your pharmacy benefit is the part of your health insurance through Medicaid that helps you pay for your prescription drugs and supplies. Some Medicaid consumers are enrolled in a Medicaid Fee for Service (FFS) Pharmacy Program, which means New York State pays pharmacies directly for your medicine. Other Medicaid consumers access their pharmacy benefits through a health plan, in Managed Care (MC) rather than FFS. In this case, New York State pays your health plan rather than the pharmacy.

Beginning April 1, 2023, all Mainstream MC Medicaid consumers will get their drugs through the NY Medicaid Pharmacy Program (Medicaid FFS). This applies to consumers enrolled in MC plans, Health and Recovery Plans (HARPs) and HIV-Special Needs Plans (HIV-SNPs). Managed Long-Term Care plans (e.g., PACE, MAP, MLTC) and the Essential Plan are not included.

For all Medicaid consumers affected by this change, our goal is to make this transition as seamless as possible by providing you the information and resources you may need in preparation of the move to the NY Medicaid Pharmacy Program (FFS).

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By email: NYRx@health.ny.gov. By phone:
The Medicaid Helpline can help you in your preferred language: 1-800-541-2831
Open Monday - Friday, 8 am - 8pm and Saturday, 9am - 1 pm
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