The state over the weekend launched a new pharmacy benefit program it says will improve prescription drug access and coverage for the eight million New Yorkers enrolled in Medicaid.
The transition to NYRx is designed to 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 Kathy 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 drug 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.
Acting Health Commissioner Dr. James McDonald said, “Today’s shift back to a fee-for-service pharmacy benefit model is the right move for New York and ensures all communities across the state will have continued access to low-cost prescription medications. I thank Governor Hochul for her continued commitment as a champion of New York’s diverse communities and fully support her proposal to add $705 million in the FY 2024 budget to provide the state’s non-profit organizations and hospitals —including Ryan White centers that serve patients enrolled in HIV/AIDS programs —with the funding they need to continue offering essential services to some of the state’s most vulnerable populations.”
New York State Medicaid Director Amir Bassiri said, “The eight million New Yorkers enrolled in Medicaid will receive their same prescription medications, only from a larger network of pharmacies at no extra cost and with fewer restrictions and less confusion than before. With this transition, our Medicaid program will now pay all pharmacies directly rather than relying on corporate middlemen who do not always act in ways that that align with the interests of Medicaid members. This will create both transparency and efficiency that will work to the benefit our members and ensure access to patient-centered, high-quality health care.”
In anticipation of NYRx being implemented, Governor Hochul committed $705 million in Medicaid dollars in her FY 2024 budget to ensure 340b healthcare 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.
Medicaid recipients or others with questions or in need of assistance with NYRx may visit the program’s website, email [email protected] 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.