Medicaid Pharmacy Program
The New York State Medicaid Pharmacy program covers medically necessary FDA approved prescription drugs. The program also covers most over the counter (OTC) products. Prescription drugs require a prescription order with appropriate required information. OTCs require a fiscal order (a fiscal order contains all the same information contained on a prescription). Certain drugs/drug categories require the doctor or other authorized 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.state.ny.us or (518) 486-3209 for Medicaid pharmacy policy related questions.
Effective October 1, 2008, Family Health Plus managed care enrollees will obtain their pharmacy services through the fee-for-service Medicaid program. Family Health Plus enrollees will receive Medicaid Benefit Identification Cards to obtain this benefit at the pharmacy. For more information and copies of letters sent to pharmacists and prescribers, please see the Family Health Plus links below.
In addition, the following information may be of interest to pharmacists and prescribers:
- Medicaid Pharmacy Reimbursement Methodology (PDF, 15KB, 1 pg)
- Medicaid Mandatory Generic Drug Program
- Medicaid Pharmacy Preferred Drug Program
- Medicaid Clinical Drug Review Program
- Medicaid Drug Utilization Review (DUR)
- Medicaid Pharmacy and Therapeutics Committee
- Medicaid Prescriber Education Program
- Medicaid Update - A monthly publication of the New York State Department of Health, Office of Medicaid Management
- Medicaid and the Medicare Part D Prescription Drug Benefit
- Nursing Home/(Foster) Child Care Drug Carve-out List
- Pharmacy Notices and Correspondence
- Medicaid Medication Therapy Management Pilot Program