Reminder: Medicaid Prescription Drug Benefit Changes Effective April 1, 2023
3/20/2023
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Posted by Provider Relations
Effective April 1, 2023, Medicaid members enrolled in Fidelis Care Managed Care Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will begin to receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. The transition does not apply to members enrolled in Managed Long-Term Care plans, the Essential Plan, or Child Health Plus (CHP).
- Medicaid members will have comprehensive drug coverage and equitable access to an extensive network of over 5,000 pharmacy providers.
- Pharmacy Procedures and Supply Codes lists supplies subject to the transition from Fidelis Care to FFS, such as enteral and parenteral nutrition, family planning and medical/surgical supplies.
- Durable Medical Equipment, Prosthetics and Supplies Manual lists items that are not subject to the transition in Sections 4.4, 4.5, 4.6, and 4.7. These items, which include durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), will remain the responsibility of Fidelis Care.
Educational Opportunities:
The New York Department of Health will be hosting a monthly webinar about the pharmacy benefit transition. Members, providers, and all interested stakeholders are welcome to attend. Registration information will be posted one week prior to each webinar date.
Upcoming Webinar Dates:
- March 21, 2023 at 1:00 PM
- April 18, 2023 at 1:00 PM
Presentations from past meetings are available in the Document Repository.
If you have any questions, please email NYRx@health.ny.gov, or contact your local Provider Relations Specialist.