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Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy benefits through the NYRx Pharmacy program, formerly known as the NYS Fee-for-Service (FFS) Pharmacy program.

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Pharmacy
  
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 - 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
  
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