NYS Medicaid Managed Care Pharmacy Benefit Information Center

MMC News

Effective April 1, 2023 the pharmacy benefit for New York State Medicaid Managed Care members will be transitioned to NYRX, the Medicaid Pharmacy Program formerly known as Medicaid Fee-for-Service. For detailed information about this transition please visit the NYRx pharmacy benefit transition website. Helpful Links

Providers, including Pharmacies, Durable Medical Equipment, Prosthetic, Orthotic and Supply Providers and Prescribers, must be enrolled in NYS Medicaid to provide services to Medicaid members. Please visit eMedNY Provider Enrollment to enroll.

For information about the NYRx preferred drug list and prior authorization criteria visit NYRx, the Medicaid Pharmacy Program

Medicaid Pharmacy List of Reimbursable Drugs

Welcome to the NYS Medicaid Managed Care Drug Quicklists page.

If you have questions or need a definition, please check our frequently asked questions (FAQs) page.

Look-Up Results: download table only:

download whole page:

To find out if a covered drug has limited strengths on formulary or other requirements such as step therapy, quantity limits and/or prior authorization requirements, please click on the "C" to view the results. To limit the health plans displayed, scroll down to the bottom of the page to customize your results.

UPPERCASE indicates brand name drug, lowercase indicates generic name drug, C=Covered, NC=Not Covered

Important Coverage Notes Regarding Results of Drug Look-Up Function:

Results reflect coverage under the Medicaid Managed Care plan's outpatient pharmacy benefit and may include drugs that are only available through a plan's Specialty Pharmacy Network. Refer to plans' website for specific instructions.
Results are not inclusive of all covered practitioner administered or certain over-the-counter drugs and or supplies. Additional drugs may be covered as a medical benefit. Please refer to the plan's website for more detailed information on physician administered drugs available as a medical benefit.
Coverage of Injectable Antipsychotics and naltrexone (Vivitrol®) for members age 20 or younger that qualify for Social Security Income (SSI) or are SSI related will continue to be provided by Medicaid FFS as a Medical Benefit only until they transition into Medicaid Managed care. For more information about the behavioral health benefit transition to Medicaid Managed care please see the please see our FAQ page.

Please note, the drug look-up reflects drug coverage under the pharmacy benefit of each plan (which may include specialty pharmacy drugs). It is not inclusive of all covered practitioner administered or certain over-the-counter drugs and or supplies. Additional drugs may be covered under the medical benefit of each plan. Please refer to the plans' website for more detailed information on physician administered drugs available under the medical benefit.

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Disclaimer

The New York State Department of Health (NYSDOH) obtains drug formulary information from Medicaid participating managed care plans on a quarterly basis. Please note NYSDOH publishes the drug formulary information as it is received. This information was last updated on 2023-01-20. As a best practice, always contact or visit your managed care plan's website to obtain the most current information regarding drug coverage.

Anti-Retroviral Quicklist

Mental Health Quicklist

Additional drug therapeutic classes

UPPERCASE indicates brand name drug, lowercase indicates generic name drug, C=Covered, NC=Not Covered

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