NYS Medicaid Managed Care Pharmacy Benefit Information Center

Managed Care Plans

Empire Blue Cross Blue Shield Health Plus

Visiting Nurse Service of NY Choice Health Plans

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.

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

Contact Information

For questions regarding your eligibility or to find out which managed care plan you are enrolled in, you may call the Medicaid Helpline at 1-800-541-2831. It is available from 8:00 a.m. through 8:00 p.m., Monday through Friday and from 9:00 a.m. to 1:00 p.m., on Saturday.

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For more information on the NY State Medicaid fee for service program visit the New York State Medicaid site.
For information about NYRx, the Medicaid Pharmacy Program visit the NYRx site.
For information about the NYRx preferred drug list and Prior Authorization program visit the Magellan Medicaid Administration site.
For more information on Medicaid Managed Care visit the New York State Managed Care site.