NYRx Medicaid Drug Program

The New York State Medicaid Drug 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.

NYRx also covers practitioner administered drugs (PADs) for members enrolled in Medicaid Fee-For-Service. These are medical drugs administered by a practitioner in an office, clinic, or outpatient setting. Effective November 19, 2026, providers are required to obtain prior authorization for certain PADs before NYS Medicaid will cover the cost of the drugs.