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Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2023
NYRx Transition Fill Period Ending

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARP), and HIV-Special Needs Plans (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy program.

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Pharmacy
  
Provider Alerts - Pharmacy Resources & Formularies - Practice Guidelines and Tips - 2023
Obtaining Physician-Administered Drugs through a Specialty Pharmacy

As a Healthfirst provider, you can get Physician-Administered Drugs (PADs) delivered to your office at no cost through White Bagging when the medication is obtained from a Healthfirst in-network specialty pharmacy provider.

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Pharmacy
  
Pharmacy Resources & Formularies - Provider Resources - 2024
Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Formularies and Formulary Changes
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Formularies
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Pertuzumab Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Trastuzumab Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Avastin-Mvasi Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Herceptin Hylecta Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Perjeta Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Provider Resources - 2023
Xolair Criteria
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Quality and Compliance
  
Pharmacy Resources & Formularies - Quality and Compliance - 2023
Pharmacy Carve Out Delay Announcement

The Pharmacy carve-out has been delayed by two years, until April 1, 2023. Review this DOH announcement to learn more.

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Medicaid