Effective May 1, 2021 the pharmacy benefit for New York State Medicaid Managed Care members will be transitioned to NYS Medicaid Fee-for-Service (FFS). For detailed information please visit the pharmacy carve-out website .

• • Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service must be enrolled in FFS in order to continue to serve Medicaid Managed Care members. Information on how to enroll can be found in the October 2020 Medicaid Update on p.10.

• • Medicaid FFS pharmacy program can be found on the NYS Medicaid Pharmacy Program site

• • FFS preferred drug program and prior authorization requirements can be found on the Magellan Medicaid Administration site

• • The NYS Medicaid Pharmacy List of Reimbursable Drugs can be found on the eMedNY site

Affinity by Molina Healthcare

Customer Service: For questions regarding policy and coverage information, call 1-800-223-7242.

Pharmacy Help Desk: For pharmacists only, with questions regarding billing issues, claims processing and assistance with claim edits, call 1-800-364-6331.

Prior Authorization: For prescribers only, for questions regarding prior authorization, call 1-877-872-4716, and to initiate prior authorization requests, fax 1-844-823-5479.

General Pharmacy Benefit Information

Medicaid Covered Drugs

Prior Authorization Form

Pharmacy Vaccine Billing Guidance

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Amida Care

Customer Service: For questions regarding policy and coverage information, call 1-646-757-7000.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Highmark Blue Cross Blue Shield of Western New York

Customer Service: For questions regarding policy and coverage information, call 1-866-231-0847 or visit our website: https://www.mybcbswny.com/wny-members/ny-home.html

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Capital District Physicians Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-388-2994.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

EmblemHealth

Customer Service: For questions regarding policy and coverage information, call 1-855-283-2146.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Excellus

Customer Service: For questions regarding policy and coverage information, call 1-800-650-4359.

Blue Choice Physician-Administered Drug Policy and Billing Guidance

Physician Dispenser Billing Guidance

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Fidelis Care

Customer Service: For questions regarding policy and coverage information, call 1-888-343-3547.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

healthfirst

Customer Service: For questions regarding policy and coverage information, call 1-855-298-2485.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Empire Blue Cross Blue Shield Health Plus

Member Services: For questions regarding policy and coverage information, call 1-833-207-3117 or visit our website.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Independent Health

Customer Service: For questions regarding policy and coverage information, call 1-800-501-3439.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

MetroPlus Health Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-303-9626.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Behavioral Health Program

MVP Health Care

Customer Service: For questions regarding policy and coverage information, call 1-800-852-7826.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Univera Healthcare

Customer Service: For questions regarding policy and coverage information, call 1-800-650-4359.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Visiting Nurse Service of New York Choice Health Plans

Customer Service: For questions regarding policy and coverage information, call 1-866-469-7774.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

Molina Healthcare

Customer Service: For questions regarding policy and coverage information, call 1-800-223-7242.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance

UnitedHealthcare Community Plan

Customer Service: For questions regarding policy and coverage information, call 1-800-493-4647.

Physician-Administered Drug Policy and Billing Guidance

COVID Guidance

Physician Dispenser Billing Guidance