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. Learn more about the Preferred Drug Program.

Most preferred drugs are available without prior authorization.

• Review the most up to date preferred drug list.

Prescribers must obtain prior authorization before prescribing non-preferred drugs.

• Forms and instructions.

For questions and comments:

• Visit NYS Medicaid Pharmacy Prior Authorization Programs
• Call the Medicaid pharmacy program (518) 486-3209, or
• E-mail ppno@health.ny.us (please note "Preferred Drug Program" in the subject area).

For consumers beginning new therapy, providers can choose a preferred medication or request a prior approval before the consumer fills their prescription.

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

Medicaid works with consumers to enroll them in an available plan depending on their 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.

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.

Information regarding the Medicaid Pharmacy Program is available through the Department of Health

Medicaid Managed Care consumers have only 90 days from date of enrollment to choose another plan in each enrollment year. Plans must 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
• step therapy under the plan's utilization management rules

When a consumer enrolls in 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. Prior approval rules will apply. Exceptions apply 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.