NYRx Pharmacy Program: Changes to Over-the-Counter Medication Coverage
2025/3/17
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Posted by Provider Relations
in
Provider News
Fidelis Care would like to alert providers of an important change to the NYRx Pharmacy Program’s coverage, effective 04/01/2025.
Changes to Over-the-Counter Medications:
Beginning 04/01/2025, per the Commissioner’s recommendation, NYRx will no longer cover the following over-the-counter items:
• Oxymetazoline containing OTC products (Afrin®)
• Phenylephrine-containing OTC products (Sudafed PE®)*
• Simethicone-containing OTC products (Gas-X)
• Glucose tablets
• Bacitracin-containing OTC products
• Neomycin-containing OTC products
• Multivitamins for members 21 and older**
*This does not include pseudoephedrine (Sudafed®) containing products, which will continue to be covered.
**This does not include prescription-only prenatal vitamins, which will continue to be covered.
How this may impact our membership:
- If members were filling any one of the medications called out above via the Pharmacy benefit through NYRx, they will no longer be covered through NYRx as of 4/1/2025.
- Member Notification:
- NYRx has notified members via various posts through their online resources. See below for direct links to posts:
- NYRx has also communicated that they will be conducting targeted outreach via NYSOH communication modalities to inform members of the impending change to coverage of these products.
Coordination of Care:
- Please be prepared to offer members alternative options if they are currently taking one of the medications that will no longer be covered through their Pharmacy Benefit
- Members can also use NYRx’s Drug Search tool to identify coverage status of Prescription Drugs & OTC Products.
Resources for Providers:
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.