As of April 1, 2023, prescriptions will not be covered by Molina Healthcare of New York, Inc. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.
Most pharmacies in New York State take the Medicaid NYRx pharmacy program. If your pharmacy does not take Medicaid, you may:
- Ask your doctor to send a new prescription to a pharmacy that takes Medicaid NYRx pharmacy program, or
- Ask your pharmacist to transfer a refill to a pharmacy that takes Medicaid NYRx pharmacy program, or
- Locate a pharmacy that takes Medicaid NYRx at: https://member.emedny.org.
You will need to show the pharmacist either your Medicaid Card or your Health Plan Card. This will tell them your Client Identification Number (CIN).
Medicaid NYRx has a list of covered drugs. Over-the-counter drugs and most drugs are on the list. This list of covered drugs can be found at: https://www.emedny.org/info/formfile.aspx.
- Some drugs need prior approval before they can be filled. This list will tell you if a drug needs prior approval. Your doctor will call to get prior approval.
- If your drug is not on this list:
Medicaid NYRx pharmacy plan also has a preferred drug list. This list can be found at: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf.
- If you need a drug that is listed as a non-preferred drug, you will be able to get a one-time only fill of this drug from April 1, 2023, through June 30, 2023.
- If you need a non-preferred drug, please contact your pharmacist or doctor so that they can get approval for you to get this drug.
The Medicaid copayment structure is not changing. Your copayment might change depending on if the drug is preferred or non-preferred.
Your pharmacy benefit also covers certain supplies:
- A list of covered supplies can be found at: https://member.emedny.org/.
- A list of preferred diabetic meters and test strips can be found at: https://newyork.fhsc.com/downloads/providers/NYRx_PDSP_preferred_supply_list.pdf.
- Medicaid will allow a one-time only fill from April 1, 2023, through June 30, 2023, for non-preferred test strips.
- You will need to change to a preferred diabetic meter and test strip.
Do you have questions or need help? The Medicaid Helpline can assist you. They can talk to you in your preferred language. They can be reached at 1-855-648-1909 TTY 1-800-662-1220.
They can answer your call:
- Monday - Friday, 8 am – 8pm
- Saturday, 9am – 1 pm
Single Statewide Medication Assisted Treatment (MAT) Formulary
STARTING OCTOBER 1, 2021: .The New York State Executive Budget for State Fiscal Year 2020-2021, in accordance to § 367-a (7) (e) of Social Services Law, enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MC) Plans and Medicaid Fee for Service (FFS) Program, Under this statewide formulary (link provided below), Medicaid MC and FFS members will follow a single formulary, where preferred products and coverage parameters are consistent across the Medicaid Program.
For more information, please visit https://newyork.fhsc.com/providers/mat.asp.
Adobe Acrobat Reader is required to view the file(s) above. Download a free version