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 and Medicaid/Managed Care enrollees. Th Medicaid Pharmacy program also covers most prescription drugs and select non-prescription drugs and medical supplies for Family Health Plus enrollees. 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.state.ny.us 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 Notices and Correspondence below.
The following information may be of interest to pharmacists and prescribers:
Pharmacy Program Information
- Pharmacists as Immunizers (see effective dates for the most recent changes)
- NYS Medicaid Program Pharmacists As Immunizers Fact Sheet (effective October 15, 2009)
- NYS Medicaid Program Pharmacists As Immunizers Fact Sheet (revised November 10, 2009)
- NYS Medicaid Program Pharmacists As Immunizers Q & A's
- October (Special Vaccine Issue) Medicaid Update (effective October 15, 2009)
- Executive Order #29 Billing Guidance (effective October 26, 2009)
- Medicaid Pharmacy Reimbursement Methodology (PDF, 15KB, 1 pg)
- Medicaid List of Reimbursable Drugs (Formulary File)
- Medicaid Mandatory Generic Drug Program
- Medicaid Pharmacy Preferred Drug Program
- Medicaid Preferred Drug Program Annual Report to the Governor and Legislature State Fiscal Year 4/1/08 to 3/31/09 (PDF, 1.11MB, 51pg)
- Medicaid Preferred Drug Program Annual Report to the Governor and Legislature State Fiscal Year 4/1/07 to 3/31/08 (PDF, 827KB, 50pg)
- Medicaid Preferred Drug Program Annual Report to the Governor and Legislature State Fiscal Year 4/1/06 to 3/31/07 (PDF, 1.03MB, 47pg)
- Medicaid Preferred Diabetic Supply Program
- Medicaid Clinical Drug Review Program
- Medicaid Pharmacy and Therapeutics Committee
- Medicaid Drug Utilization Review Program (DUR)
- Medicaid Medication Therapy Management Pilot Program
- Medicaid Prescriber Education Program
- Medicaid and the Medicare Part D Prescription Drug Benefit
- Nursing Home/(Foster) Child Care Drug Carve-out List