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Pharmacy Archive

• A New Provider Communication Has Been Posted (4/22/25, 132KB)
• Updated Provider Manual (4/4/25, 309KB)
• A New Provider Communication Has Been Posted (3/27/25, 198KB)
• Notice for Upcoming Over-The-Counter Coverage Changes (3/25/25, 179KB)
• A New Provider Communication Has Been Posted (3/20/25, 88KB)
• Updated - NYRx Top Edit Resource (3/19/25, 173KB)
• A New Provider Communication Has Been Posted (3/10/25, 150KB)
• Outreach to CDPAP Consumers and Caregivers Ahead of April 1 Transition to Statewide FI (3/10/25, 141KB)
• A New Provider Communication Has Been Posted (3/6/25, 130KB)
• A New Provider Communication Has Been Posted (3/3/25, 113KB)
• A New Provider Communication Has Been Posted (2/14/25, 152KB)
• Update for DMEPOS Providers (1/31/25, 138KB)
• A New Provider Communication Has Been Posted (1/16/25, 134KB)
• A New Provider Communication Has Been Posted (12/27/24, 132KB)
• Top Edit Resource Updated (12/18/24, 142KB)
• A New Provider Communication Has Been Posted (11/20/24, 153KB)
• A New Provider Communication is Available (11/13/24, 144KB)
• New Provider Communications are Available (10/30/24, 142KB)
• New Provider Communications are Available (10/23/24, 122KB)
• A New Provider Communication is Available (10/21/24, 141KB)
• Updated Provider Manual (10/2/24, 303KB)
• NYRx Reimbursement (10/1/24, 146KB)
• A New Provider Communication is Available (9/24/24, 142KB)
• Two New Provider Communications Are Available (9/9/24, 175KB)
• The Medical Supply Procedure Codes & Coverage Guidelines and DMEPOS Fee Schedule Have Been Updated (9/3/24, 140KB)
• A New Provider Communication is Available (8/23/24, 294KB)
• A New Provider Communication is Available (8/20/24, 292KB)
• A New Provider Communication is Available (7/24/24, 166KB)
• A New Provider Communication is Available (7/19/24, 144KB)
• A New Provider Communication Has Been Posted (7/11/24, 132KB)
• A New Provider Communication Has Been Posted (7/2/24, 152KB)
• A New Provider Communication Has Been Posted (6/25/24, 309KB)
• A New Provider Communication Has Been Posted (6/24/24, 305KB)
• A New Provider Communication Has Been Posted (6/18/24, 293KB)
• Updated Provider Manual (6/6/24, 193KB)
• A New Provider Communication Has Been Posted (5/15/24, 217KB)
• Updated Provider Manual (5/13/24, 197KB)
• A New Provider Communication Has Been Posted (5/9/24, 179KB)
• New Provider Communications Have Been Posted (5/8/24, 168KB)
• A New Provider Communication is Available (4/9/24, 323KB)
• A New Provider Communication is Available (4/3/24, 273KB)
• A New Provider Communication is Available (3/22/24, 192KB)
• DME Policy Guidelines, Procedure Codes and Fee Schedule Updated (3/14/24, 151KB)
• A New Provider Communication is Available (3/14/24, 147KB)
• A New Provider Communication is Available (3/8/24, 342KB)
• A New Provider Communication is Available (2/16/24, 342KB)
• A New Provider Communication is Available (1/26/24, 348KB)
• A New Provider Communication is Available (1/8/24, 217KB)
• Updated Fee Schedule (1/3/24, 142KB)
• Updated Provider Manual (12/29/23, 197KB)
• A New Provider Communication is Available (12/22/23, 174KB)
• A New Provider Communication is Available (12/21/23, 342KB)
• A New Provider Communication is Available (12/14/23, 280KB)
• Addition of Parenteral Nutrition HCPCS B4187 (12/7/23, 138KB)
• A New Provider Communication is Available (12/5/23, 222KB)
• A New Provider Communication is Available (12/1/23, 140KB)
• A New Provider Communication is Available (11/30/23, 149KB)
• A New Provider Communication is Available (11/20/23, 145KB)
• A New Provider Communication is Available (11/2/23, 205KB)
• A New Provider Communication is Available (10/30/23, 420KB)
• Clarification to Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) Fiscal Order Acceptance Policy (10/26/23, 150KB)
• A New Provider Communication is Available (10/24/23, 372KB)
• Information for Prescribing and Dispensing Providers of Enteral Products for Medicaid Members (10/23/23, 123KB)
• Updated Fee Schedule (10/13/23, 187KB)
• A New Provider Communication is Available (10/10/23, 242KB)
• Updated Continuous Glucose Monitoring Criteria (10/3/23, 148KB)
• Updated Fee Schedule (10/2/23, 142KB)
• NYRx BLTG Program Update (10/2/23, 156KB)
• UPDATED Provider Communication (9/22/23, 321KB)
• A New Provider Communication is Available (9/15/23, 433KB)
• A New Provider Communication is Available (8/30/23, 258KB)
• A New Provider Communication is Available (8/25/23, 184KB)
• A New Provider Communication is Available (8/23/23, 258KB)
• Updated Provider Manual (8/14/23, 171KB)
• Updated Fee Schedule (7/31/23, 187KB)
• A New Provider Communication is Available (7/14/23, 225KB)
• Updated Fee Schedule - (7/13/23, 192KB)
• PRIOR AUTHORIZATIONS FOR MEDICAL SUPPLIES (7/7/23, 160KB)
• NYRx Medicaid Providers Dispense Brand Name Drug when Less Expensive than Generic Program (7/6/23, 176KB)
• Medicaid Drug Rebate Program Updates for July 1st, 2023 (7/3/23, 178KB)
• A DMEPOS Provider Communication is Now Available (6/27/23, 144KB)
• Important Information: Coordination of Benefit (COB) Reversals with Other Coverage Code (OCC) value "4" (6/23/23, 158KB)
• A New Provider Communication is Available (6/21/23, 150KB)
• A New Provider Communication has been Posted (6/13/23, 186KB)
• Two (2) New Provider Communications have been Posted (6/6/23, 153KB)
• Updated: Top Edit Resource (5/31/23, 133KB)
• Update to New York State Medicaid Fee-for-Service Pharmacy Billing Instructions for Coordination of Benefits Submission (5/26/23, 199KB)
• Updated Provider Manual (5/22/23, 147KB)
• Updated: Top Edit Resource (5/16/23, 142KB)
• Updated Fee Schedule (5/15/23, 142KB)
• New Pharmacy Provider Training Videos Available (5/12/23, 143KB)
• A New Provider Communication is Available (5/10/23, 298KB)
• A New Provider Communication is Available (5/8/23, 222KB)
• Updated: Top Edit Resource (5/4/23, 139KB)
• Updated Fee Schedule - (5/4/23, 147KB)
• Updated Fee Schedule - (5/2/23, 142KB)
• Updated Medical Supply Codes Manual (4/21/23, 144KB)
• Updated: Top Edit Resource (4/20/23, 139KB)
• Enteral Policy/Enteral Web Portal Training Webinar (4/19/23, 196KB)
• A Provider Communication is Now Available (4/17/23, 142KB)
• New Pharmacy Provider Training Videos Available (4/17/23, 145KB)
• Attention Pharmacy Providers: Important Information Regarding Claims Processing (4/13/23, 146KB)
• New Pharmacy Provider Training Videos Available (4/12/23, 145KB)
• Two (2) New Provider Communications have been Posted (4/11/23,151KB)
• Updated: Top Edit Resource (4/10/23,106KB)
• Medical Supply Codes have been Updated (4/7/23, 142KB)
• Reminder: Member CIN on Managed Care Card AND NYS Benefit Card (4/5/23, 205KB)
• Pharmacy - New Provider / New Biller Webinar (4/5/23, 180KB)
• NYRx, The Medicaid Pharmacy Program - Claims Submitted 4/1 - 4/4/2023 (4/4/23, 164KB)
• Important Information for Pharmacies Submitting Medicaid 340B Drug Claims (4/2/23, 187KB)
• Important Information for Pharmacies Regarding the Pharmacy Transition/NYRx (4/2/23, 202KB)
• Updated ProDUR-ECCA D.0 Provider Manual (3/31/23,148KB)
• A New Provider Communication and an update to the Policy Guidelines have been posted (3/27/23,166KB)
• A New Provider Communication is Now Available (3/20/23, 239KB)
• A New Provider Communication is Now Available (3/14/23, 254KB)
• ATTENTION: The Medicaid Enteral Web Portal Has Gone Live as of 3/2/23 (3/7/23, 168KB)
• Pharmacy - New Provider / New Biller Webinar (2/28/23, 161KB)
• A New Provider Communication is Now Available (2/23/23, 240KB)
• Attention: NYS Medicaid Enteral Prior Authorization Enhancements - Web Portal Launch and Training Sessions (2/16/23, 203KB)
• Pharmacy Fee Schedule Updated (2/10/23, 246KB)
• Pharmacy Fee Schedule Updated (1/30/23, 161KB)
• Pharmacy Fee Schedule Updated (1/24/23, 162KB)
• A New Provider Communication is now Available (1/17/23, 163KB)
• A New Provider Communication is Available (1/12/23, 162KB)
• Policy Guidelines Manual Updated (1/11/23, 163KB)
• A New Provider Communication is now Available (12/30/22, 162KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (11/23/22, 125KB)
• Pharmacy Fee Schedule Updated (11/7/22, 125KB)
• Pharmacy Fee Schedule Updated (10/20/22, 126KB)
• Pharmacy Fee Schedule Updated (10/6/22, 144KB)
• Pharmacy Fee Schedule Updated (9/8/22, 144KB)
• Pharmacy Fee Schedule Updated (8/3/22, 144KB)
• Pharmacy Fee Schedule Updated (6/30/22, 144KB)
• Attention: New York State Medicaid Fee-For-Service Providers Administering Drugs (6/7/22, 213KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (6/6/22, 144KB)
• Updated Pharmacy Manual Policy Guidelines (5/4/22, 144KB)
• Pharmacy Fee Schedule Updated (3/15/22, 143KB)
• Updated Pharmacy Manual Policy Guidelines (12/23/21, 236KB)
• Pharmacy Fee Schedule Updated (10/29/21, 236KB)
• Pharmacy Fee Schedule Updated (10/1/21, 236KB)
• Pharmacy Fee Schedule Updated (9/22/21, 236KB)
• Pharmacy Fee Schedule Updated (9/20/21, 236KB)
• Updated Billing and Reimbursement Guidelines for HCPCS Code A4232 (9/17/21, 253KB)
• Pharmacy Fee Schedule Updated (8/27/21, 236KB)
• NYS COVID-19 State Disaster Emergency, Executive Order No. 202 (7/23/21, 270KB)
• The Issue That Caused Some Claims for Services Ordered by Nurse Practitioners to Incorrectly Deny has been Resolved (7/12/21, 251KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (7/2/21, 237KB)
• Updated Pharmacy Manual Policy Guidelines (6/24/21, 236KB)
• Updated Pharmacy Manual Policy Guidelines (4/30/21, 236KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (4/29/21, 237KB)
• IVR Enteral PA Webinar has been posted (4/22/21, 240KB)
• Webinars for the Interactive Voice Response System (IVR) for Medicaid Fee for Service (FFS) Enteral Product Authorizations (3/24/21, 260KB)
• A New Physician Provider Communication is Available (3/16/21, 240KB)
• An updated DMEPOS Policy Manual has been posted (2/10/21, 245KB)
• Pharmacy Fee Schedule Updated (1/5/21, 236KB)
• The Pharmacy Billing Guidelines Updated (12/4/20, 236KB)
• Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service (FFS) (11/30/20, 293KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (9/8/20, 236KB)
• Pharmacy Procedure Codes and Fee Schedules Updated (8/18/20, 237KB)
• Provider Communication for Automatic Blood Pressure Monitors (6/3/20, 236KB)
• Attention Pharmacy Providers: Issue That Caused Some Pharmacy Claims to Incorrectly Deny has been Resolved (5/19/20, 253KB)
• Pharmacy Fee Schedule Updated (4/30/20, 235KB)
• Updated Pharmacy Manual Policy Guidelines (10/23/19, 210KB)
• Pharmacy Procedure Codes and Fee Schedule Updated (7/31/19, 154KB)
• 2019 Pharmacy Procedure Codes and Pharmacy Fee Schedule Updated (5/14/19, 154KB)
• Pharmacy Fee Schedule Updated (12/27/18, 154KB)
• A New Provider Communication Is Available (12/19/18, 154KB)
• Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program (10/26/18, 168KB)
• A New Provider Communication Is Available (8/10/18, 154KB)
• A New Pharmacy Provider Communication Is Now Available (5/17/18, 153KB)
• Pharmacy Procedure Codes and Fee Schedule Updated (3/28/18, 153KB)
• Important Enteral Prior Approval and Claim Requirement Change (3/9/18, 159KB)
• Pharmacy Fee Schedule Updated (12/27/17, 158KB)
• A New Provider Communication is Available (12/22/17, 158KB)
• A New Provider Communication is Available (10/27/17, 155KB)
• ATTENTION: Topical Oxygen Wound Therapy (TOWT) Continues to be Covered Until Further Notice (6/26/17, 178KB)
• A New Provider Communication is Available (6/14/17, 177KB)
• Important Incontinence Supply Management Program Rate Change Update (5/16/17, 177KB)
• Incontinence Supply Rate Change Postponement (4/3/17, 181KB)
• A New Provider Communication is Available (3/24/17, 177KB)
• Pharmacy Procedures Codes Updated (3/23/17, 177KB)
• A New Provider Communication is Available (3/6/17, 155KB)
• A New Pharmacy Communication is Available (2/15/17, 177KB)
• Pharmacy OTC and Supply Fee Schedule Updated (12/29/16, 176KB)
• A New Pharmacy Provider Communication is Available (12/28/16, 180KB)
• A New Pharmacy Provider Communication is Available (11/11/16, 180KB)
• A Pharmacy Provider Communication is Now Available (10/26/16, 182KB)
• A Pharmacy Provider Communication is Now Available (9/6/16, 177KB)
• A Pharmacy Provider Communication is Now Available (8/18/16, 172KB)
• Approval of Incontinence Supply Management Program (6/2/16, 19KB)
• A Pharmacy Provider Communication is Now Available (5/26/16, 177KB)
• Pharmacy Fee Schedule Updated (12/31/15, 76KB)
• A Pharmacy Provider Communication is Now Available (9/30/15, 76KB)
• Notification to Ordering and Billing Providers of Enteral Formula Products (9/29/15, 77KB)
• A New Provider Communication is Now Available (9/23/15, 76KB)
• OPRA Prescription Requirements for Unlicensed Residents, Interns and Foreign Physicians in Training (6/17/15, 90KB)
• 2015 Pharmacy Fee Schedule Has Been Updated (5/6/15, 76KB)
• A Provider Communication for Pharmacy Providers is Now Available (4/21/15, 76KB)
• Pharmacy Manual and Fee Schedule has been updated (4/1/15, 76KB)
• Pharmacy Fee Schedule Updated (3/11/15, 76KB)
• Reminder: Billing Instructions for 340B Drug Claims (2/24/15, 77KB)
• Attention: New Medicaid FFS Pharmacy Early Fill Edit (1/21/15, 75KB)
• A Provider Communication for Pharmacy Providers is Now Available (12/22/14, 159KB)
• Guidance for Pharmacies Assisting Medicaid Members During the State Disaster Emergency Declared 11/18/2014 (11/24/14, 142KB)
• A Provider Communication for Pharmacy Providers is Now Available (11/6/14, 75KB)
• Attention Pharmacy Providers: Copaxone 20mg Billing Unit Changes Effective Q4 2014 (10/17/14, 143KB)
• A Provider Communication for Pharmacy Providers is Now Available (10/14/14, 75KB)
• Ordering, Prescribing, Referring, Attending (OPRA) Prescription Requirements for Unlicensed Residents, Interns and Foreign Physicians in Training (9/15/14, 77KB)
• Attention Prescribers: Final e-Prescriber Payments to be Issued By eMedNY (9/12/14, 188KB)
• A Provider Communication for Pharmacy Providers is Now Available (9/3/14, 75KB)
• Attention Prescribers: Final e-Prescriber Payments to be Issued By eMedNY (8/26/14, 76KB)
• A Provider Communication for Pharmacy Providers is Now Available (6/27/14, 152KB)
• A Provider Communication to Pharmacy Providers Regarding Prescriptions Written by OPRA Providers is Now Available (5/29/14, 154KB)
• Important Notice to Pharmacy Providers Regarding Prescriptions Written by Ordering/Prescribing/Referring/Attending (OPRA) Providers (5/1/14, 76KB)
• Electronic Prescribing Incentive Payments Discontinued Effective April 1, 2014 (4/9/14, 66KB)
• Pharmacy Procedures Codes & Fee Schedule Updated (4/4/14, 65KB)
• 2014 DME procedure codes section and fee schedule (3/28/14, 66KB)
• Quarterly National Correct Coding Initiative (NCCI) Edits Updated (3/24/14, 71KB)
• Medicaid Pharmacy Prior Authorization Programs Update (3/21/14, 65KB)
• Important Notice to Pharmacy Providers Regarding Prescriptions Written by Ordering/Prescribing/Referring/Attending (OPRA) Providers (2/19/14, 76KB)
• Medicaid Pharmacy Prior Authorization Programs Update (2/18/14, 77KB)
• Urgent Update: Notice to Pharmacy Providers Regarding Prescriptions Written by Ordering/Prescribing/Referring/Attending (OPRA) Providers (2/6/14, 66KB)
• Important Notice to Pharmacy Providers Regarding Prescriptions Written by Ordering/Prescribing/Referring/Attending (OPRA) Providers (1/30/14, 76KB)
• A Provider Communication for Pharmacy Providers is Now Available (1/22/14, 65KB)
• Delay in Ordering/Referring Editing Implementation in FFS Medicaid Pharmacy Claims Only (12/24/13, 70KB)
• Medicaid Prescription Footwear and Stocking Benefit Update (12/12/13, 72KB)
• Change in Coverage of Barbiturates for Dual Eligible Population (12/10/13, 66KB)
• Medicaid Pharmacy Prior Authorization Programs Update (11/22/13, 156KB)
• Provider Satisfaction Survey (10/16/13, 66KB)
• ATTENTION PROVIDERS: Pharmacists as Immunizers Fact Sheet (10/04/13, 65KB)
• Enteral Nutritional Formula Phone Line (09/27/13, 66KB)
• Attention: Influenza Vaccine Coverage Expanded (09/23/13, 66KB)
• Medicaid Pharmacy Prior Authorization Programs Update (09/10/13, 80KB)
• Enteral Nutritional Formula Webinar Power Point Presentation (07/29/13, 52KB)
• Webinar: Enteral Nutritional Formula Regulation and Utilization Management Update (07/23/13, 52KB)
• Enteral Formula Prior Authorization Phone System Update (07/18/13, 54KB)
• Enteral Formula Telephone Authorization System Update (07/11/13, 52KB)
• Fee for Service Enteral Formula Prior Authorization (07/01/13, 54KB)
• Incontinence Prescriber Communication ICD-9 Quantity Tool (06/28/13, 52KB)
• NYS Medicaid Ordering/Prescribing/Referring/Attending (OPRA) Provider Enrollment Impact on Pharmacy Claims (06/25/13, 52KB)
• Enteral Nutritional Formula Benefit Update (06/14/13, 61KB)
• NYS Medicaid Ordering/Prescribing/Referring/Attending (OPRA) Provider Enrollment Impact on Pharmacy Claims (06/06/13, 65KB)
• Specialty Mail Order Pharmacy in Medicaid Managed Care (06/05/13, 53KB)
• Medicaid Fee- for- Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program (05/31/13, 64KB)
• Medicaid Pharmacy Prior Authorization Programs Update (05/06/13, 66KB)
• Edit 02166 'Delay Reason 11(Other Delay) Invalid' Will Deny Claims Beginning April 25, 2013 (04/25/13, 59KB)
• Updated Pharmacy Fee Schedule and Procedure Codes are Now Available (4/09/13, 52KB)
• Upcoming Training for Obtaining DVS for Incontinence Supplies via ePACES (04/01/13, 53KB)
• Pharmacy Attention All Providers Dispensing Breast Pumps (03/25/13, 51KB)
• Edit 02165 - Delay Reason 10 (Administration Delay in the Prior Approval Process) Invalid will deny claims beginning March 7, 2013 (03/05/13, 58KB)
• Upcoming Training for Obtaining DVS for Incontinence Supplies via ePACES (02/22/13, 57KB)
• Extension to February 1, 2013 for Billing Incontinence Supplies on the DME Claim Format (12/28/12, 65KB)
• Prescriber Prevails in Medicaid Managed Care for Atypical Antipsychotics (12/24/12, 62KB)
• Effective date for billing incontinence supplies on DME claim moved to January 1, 2013 (12/14/12, 52KB)
• State of Emergency Notification For Pharmacy(10/30/12, 52KB)
• New Provider Communications for SMAC are Now Available (10/17/12, 51KB)
• A Provider Communication for Pharmacy Providers is Now Available (10/02/12, 51KB)
• Important Reminder for All Ordering and Billing Providers of Incontinence Supplies (08/30/12, 52KB)
• OMH RTF Prescription Drug Carve-Out (07/27/12, 53KB)
• Provider Communication on HCPCS Code E2100 Update (05/16/12, 52KB)
• Drug Acquisition Costs and Associated Costs of Dispensing (03/02/12, 60KB)
• Attention Podiatrists, Dentists, Optometrists and Pharmacies (12/28/11, 39KB)
• Upcoming Changes to the Fee-for-Service Pharmacy Prior Authorization Process (12/15/11, 48KB)
• Secondary Claims Cannot be Billed to Medicaid Before the Primary Payer's Remittance is Received (11/08/11, 40KB)
• Enteral and Parenteral Pump Prior Authorization Update (11/02/11, 38KB)
• Medicaid Pharmacy Retroactive Adjustments Beginning 10/10/2011 (10/07/11, 47KB)
• Attention Pharmacies and Prescribers: Eligibility Transaction Update (10/05/11, 38KB)
• Pharmacy Benefits to be Bundled into Medicaid Managed Care Starting 10/1/2011 (09/30/11, 38KB)
• Announcement of Upcoming Changes to Fee-For-Service Pharmacy Reimbursement (08/19/11, 45KB)
• Attention Pharmacy Providers submitting Version NCPDP 5.1 claims for Enteral Nutritional Formula with Modifier “BO” (by Oral) (07/20/11, 39KB)
• New ProDUR/ECCA Provider Manual Now Available (06/09/11, 38KB)
• Pharmacy Procedure Codes and Fee Schedule Updated (05/06/11, 38KB)
• Enteral Nutritional Formula Benefit Update (04/19/11, 40KB)
• Prescription Footwear & Compression Stocking Benefit Update (04/11/11, 31.75KB)