NYRx, The Medicaid Pharmacy Program Notice to Providers: Program Update

NYRx, The Medicaid Pharmacy Program Notice to Providers: Program Update

The NYRx Clinical Call Center is experiencing higher than normal call and fax volume. Prescribers should not send duplicate prior authorization (PA) requests to NYRx. Prescribers may experience a higher volume of requests for PA, but only one submission is necessary. Pharmacies should only request one PA for each member for each drug. Duplicate requests slow down the processing time at the NYRx Clinical Call Center. For more information, refer to NYRx Notice to Providers: Duplicate Prior Authorization Requests. To review how to submit a PA to NYRx, refer to the NYRx Prior Authorization Submission Guide.

Enhancements have been made to the NYRx clinical criteria system editing. The clinical criteria have not changed and should be reviewed on the NYRx Preferred Drug List prior to obtaining a PA. Preferred products should be prescribed when clinically appropriate. In most cases, preferred products will not require a PA when prescribed according to FDA labeling. To review NYRx preferred products only, refer to the NYRx Preferred Drug Quick List.

Resources

For more information regarding specific NYRx drug class criteria, refer to the following drug class coverage overviews:

• NYRx Drug Class Coverage Overview: Antipsychotics – Second Generation
• NYRx Drug Class Coverage Overview: Benzodiazepines
• NYRx Drug Class Coverage Overview: Central Nervous System Stimulants and Other Agents for Attention Deficit Hyperactivity Disorder

Additional drug class coverage overviews are available on the NYRx Education & Outreach website.

Contact Information

The NYRx E&O Call Center is available by phone at 1-833-967-7310 from 8:00 AM to 5:00 PM ET, Monday through Friday, excluding holidays, or by email at [email protected].

The NYRx E&O team hosts virtual office hours every week for stakeholders to ask questions related to NYRx and care coordination. Office hours are also available by appointment. For more information, email [email protected] or visit the NYRx Education & Outreach website.