NYRx Medicaid Pharmacy Program

The New York State Medicaid Pharmacy program, NYRx, covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid members. Prescription drugs require a prescription order with appropriate required information. Non-prescription drugs, often referred to as Over-the-Counter or OTC drugs, require a fiscal order (a fiscal order contains all the same information contained on a prescription). Certain drugs/drug categories require the prescribers to obtain prior authorization. Information on this benefit can be found in the New York State Medicaid State Plan Amendment.

On April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) had their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. The transition did not apply to members enrolled in Managed Long-Term Care plans (e.g., PACE, MAP, and MLTC), or the Essential Plan.

Providers, including prescribers, pharmacies and DMEPOS providers, must be enrolled in NYS Medicaid to receive reimbursement for services provided to Medicaid members. See provider enrollment and the pharmacy manual for more information.

For information about enrollment exceptions, please review the Pharmacy Billing Guidance Exceptions for Non-Enrolled Prescribers in Medicaid.