Pharmacy Pearls: NYS Medicaid Drug Coverage Update 2023

Pharmacy Pearls: NYS Medicaid Drug Coverage Update 2023

March 28th, 2023 | Pharmacy PearlsAdditional Topics
Starting April 1, 2023, NYS Medicaid-enrolled patients will have a change in who is providing their prescription benefits. Currently, NYS Medicaid-enrolled patients access prescription benefits through a health plan, and the state reimburses the health plan for prescription drugs. Beginning on April 1, NYS Medicaid-enrolled patients will access their prescription benefits through a new program called NYRx. The state will pay the pharmacy directly for prescriptions and certain supplies. Health plans will still be responsible for providing medical benefits to NYS Medicaid-enrolled patients; the only thing changing is their pharmacy benefit. Although the transition to the NYRx Medicaid Pharmacy Program is scheduled to go live on April 1, 2023, political and budgetary factors may affect the existence of this program and/or the go-live date. We will continue to provide updates as they come on this transition.


In this edition of Pharmacy Pearls, you will find a comprehensive 2-page document explaining this change, providing providers with resources, and offering a list of helpful things for patients and providers to know. You will notice many embedded links in this document to help you easily access more detailed information.

As always, we welcome any questions or feedback you may have. Just email the Pharmacy Team.

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