Effective April 1, 2023 Changes to Prescription Drug Coverage

Beginning April 1, 2023, all Medicaid members enrolled in SelectHealth will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Information about the transition of the pharmacy benefit from SelectHealth to NYRx, the Medicaid Pharmacy Program can be found HERE.

General information about NYRx, the Medicaid Pharmacy Program can be found HERE along with information for Members and Providers.

Most pharmacies in New York State take Medicaid NYRx. If your pharmacy does not take Medicaid NYRx, you can:

• Ask your doctor to send a new prescription that takes Medicaid NYRx, or ask your pharmacist to transfer a refill to a pharmacy that takes Medicaid NYRx.

• Click here to locate a pharmacy that takes Medicaid NYRx

You will need to show your pharmacist either your Medicaid Card or your Health Plan Card. This will tell them your Client Identification Number (CIN). Your CIN is located at the bottom of your Health Plan Card.

Medicaid NYRx has a list of covered drugs

• Over-the-counter drugs and most drugs are on the list. This list of covered drugs can be found here.

• Some drugs need prior approval before they can be filled. This list will tell you if a drug needs prior approval. Your doctor will call to get prior approval.

If your drug is not on the list:

• Your doctor can ask Medicaid NYRx for approval to let you get the drug, or your pharmacist can talk to your doctor about changing to a drug that is on the list.

Medicaid NYRx also has a preferred drug list that can be found here

• If you need a drug that is listed as a non-preferred drug, you will be able to get a one-time only fill of this drug from April 1, 2023 – June 30, 2023.

• If you need a non-preferred drug, please contact your pharmacist or doctor so that they can get approval for you to get this drug.

Your Medicaid NYRx pharmacy benefit covers certain medical supplies

• A list of medical supplies can be found here on the Medicaid NYRx website.

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