New York State launches new Medicaid pharmacy-benefit program

ALBANY, N.Y. — New York State has introduced a long-planned, new pharmacy-benefit program, which state officials say will improve prescription-drug access and coverage for the 8 million New Yorkers enrolled in Medicaid statewide.

The transition will enable Medicaid recipients to access more prescription medications with “fewer restrictions,” the office of Gov. Kathy Hochul stipulated Saturday in announcing the launch of the program called NYRx. It’ll also “reduce confusion” over the brand-name and generic drugs covered by the program and create the largest pharmacy network in New York state.

“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 … Federally Qualified Health Centers, to ensure this change is seamless and has positive impacts across our state,” Hochul said in a release.

Under the NYRx model, the 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 state says. New York State contends that 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 will offer Medicaid recipients 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 U.S. Food & Drug Administration (FDA)-approved medications, which will broaden prescription-drug coverage for Medicaid recipients, per the state.