Governor Hochul Launches New Statewide Medicaid Pharmacy Benefit Program

 

Long-Awaited Transition to NYRx Provides Eight Million Members Expanded Access to Prescription Medications at More Than 5,000 Pharmacies Statewide

Change Invests $705 Million in Medicaid Funding Directly to 340b providers, including Ryan White HIV/AIDS programs, Federally Qualified Health Centers and Hospitals

 Governor Kathy Hochul today launched NYRx, the state's new pharmacy benefit program, which will improve prescription drug access and coverage for the eight million New Yorkers enrolled in Medicaid statewide. The long-awaited transition will enable Medicaid recipients to access more prescription medications with fewer restrictions, reduce confusion over the brand-name and generic drugs covered by the program, and create the largest pharmacy network in New York State.

"The transition to NYRx today is in the best interest of those New Yorkers relying on Medicaid for affordable prescription medication," Governor Hochul said. "In addition to expanding coverage and access through this program, we are also committing hundreds of millions of additional Medicaid dollars to reinvest in critical providers, including Ryan White programs and Federally Qualified Health Centers, to ensure this change is seamless and has positive impacts across our state."

Under the NYRx model, New York State's Medicaid program will pay pharmacy costs directly, eliminating the need for managed care organizations to administer this benefit through pharmacy benefit managers. The new process creates transparency in reimbursements to pharmacies, leverages the state's purchasing power to negotiate with drug manufacturers, and streamlines administration for practitioners.

NYRx also improves coverage for Medicaid recipients by opening access to a statewide network of more than 5,000 pharmacies. In addition, the change establishes one comprehensive list of the brand-name and generic medications covered under the program, including all FDA-approved medications, which will broaden prescription drugs coverage for Medicaid recipients.

Additionally, NYRx will streamline the process for practitioners. Instead of working through varying rules and limitations for coverage under managed care organizations, pharmacists and physicians will be able to prescribe medication based on a uniform list that is less restrictive and governed by an independent public board of experts.

In anticipation of NYRx being implemented, Governor Hochul committed $705 million in Medicaid dollars in her FY 2024 budget to ensure 340b health care providers that received critical funding through their pharmacy programs aren't negatively impacted by the transition. Of the $705 million, the budget reinvests $30 million in state Medicaid funding to Ryan White HIV/AIDS programs, $250 million in state and federal Medicaid funding into Federally Qualified Health Centers, and $425 million in state and federal Medicaid funding into hospitals.

Initially adopted in 2020 in the FY 2021 Budget, the transition will also help address New York State's rapid growth in Medicaid pharmacy costs, which has been driven primarily by pharmacy benefit managers and other intermediaries in the prescription medication supply chain. The transition was delayed by the FY 2022 Budget, which pushed implementation until today, April 1, 2023.

Medicaid recipients or others with questions or in need of assistance with NYRx may visit the program's website, email NYRx@health.ny.gov or contact the Medicaid Helpline at 1-855-648-1909 or TTY 1-800-662-1220. The Helpline is available 8 a.m. to 8 p.m. Monday through Friday, and 9 a.m. to 1 p.m. on Saturday.

The state Department of Health also prepared a fact sheet available in multiple languages for consumers answering basic questions about the transition. Additional information is available at the on the eMedNY website.