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Office of Mental Health

Summary of Medicaid Preferred Drug Program and Managed Care Pharmacy Benefit

New York State Medicaid Preferred Drug List

The Medicaid Preferred Drug Program (PDP) promotes the use of less expensive, equally effective prescription drugs when medically appropriate. The Medicaid Pharmacy and Therapeutics (P&T) Committee reviews drug classes and makes recommendations to the Commissioner of Health regarding the selection of preferred and non-preferred drugs within certain drug classes. These recommendations are based on public comment and testimony, review of objective clinical research, then review of drug cost information. The most up to date preferred drug list. Leaving OMH site Most preferred drugs are available without prior authorization. Prescribers must obtain prior authorization before prescribing non-preferred drugs. The forms and instructions.Leaving OMH site

For questions and comments:

Please be aware of the medications included on the preferred drug list. For consumers beginning new therapy, either choose a preferred medication or request a prior approval before sending the consumer to the pharmacy with a prescription to fill.

Transfer of Medicaid Fee for Service Consumers into New York State (NYS) Medicaid Managed Care Plans

NYS Department of Health (DOH) began the transition from the traditional fee for service coverage to Medicaid Managed Care Coverage on October 1, 2011. The implementation process is ongoing and will take time (several years) to complete. Medicaid will work with consumers to enroll them into one of the plans available across the state depending on the county of residence. There is a choice of managed care plans in most counties; however a few counties have only one plan. You can identify the managed care plans available in your county on the DOH website: Leaving OMH site

What if the consumer only has a Medicaid Identification card, does not have a plan identification card and does not know the name of his/her plan? Prescribers can confirm a member's enrollment information by calling the NYS DOH MMISTelephone eligibility line at 1-800-997-1111.

The current Medicaid Managed Care plans formulary coverage, including anti-depressants and anti-psychotics, is available here.Leaving OMH site Once you determine which plan the consumer has been enrolled in, you can review the consumer's medication coverage. Medicaid Managed Care consumers have only 90 days from date of enrollment to choose another plan available in their county in each enrollment year. Plans are required to provide a one-time, temporary fill for non-formulary drugs for up to a 30-day supply of medication. This includes drugs that are on a plan's formulary but require prior authorization or step therapy under the plan's utilization management rules.

Once the consumer is enrolled with a Managed Care plan, all pharmacy benefits (prescription and certain non-prescription (OTC) drugs, medical supplies, hearing aid batteries, enteral nutritional formula) are provided by that plan and the plan's formulary and prior approval rules will apply. There is an exception that applies to consumers who have Supplemental Security Income (SSI) or SSI-related enrollees and the coverage of long acting injectable antipsychotics.

Comments or questions about the information on this page can be directed to the Bureau of Health Services.