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Medicaid Drug Coverage

Formulary & Drug Lists for Medicaid Members

Pharmacy Billing Guidance Exceptions for Non-Enrolled Prescribers

The New York State (NYS) Medicaid program requires enrollment of all licensed prescribers and pharmacies who serve Medicaid members, including prescribing practitioners identified on pharmacy claims per the Centers for Medicare and Medicaid Services (CMS) and federal regulations.

Medication-Assisted Treatment (MAT) Formulary Change

On December 22, 2021, Governor Hochul signed Chapter 720 of the Laws of 2021. This law amends Social Services Law and the Public Health Law, in relation to medication for the treatment of substance use disorders. Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance-use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance-use disorder. Prescriptions written outside of accepted guidelines may be subject to prior authorization.

Medicaid Drug Coverage Policies