NYRx Expands Brand Less Than Generic Program: Key Updates for Prescribers and Pharmacists
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New York’s Medicaid program, NYRx, is implementing important changes to its Brand Less Than Generic (BLTG) Program effective August 21, 2025. This program ensures patients receive the most cost-effective option—sometimes a brand-name medication—when it is less expensive than the generic alternative.
The latest update adds Complera® to the program, while Pradaxa®, Sandostatin LAR®, and Sprycel® will be removed. Under State Education Law, pharmacists are required to dispense the lower-cost, therapeutically equivalent option, which may be the brand drug when NYRx designates it as more affordable.
Notably, prescriptions for BLTG medications:
- Do not require “Dispense as Written” (DAW) or “Brand Medically Necessary.”
- Carry a generic copayment for patients.
- Are reimbursed at the brand rate or usual and customary price, whichever is lower.
- Require pharmacies to bill using DAW code 9 to avoid claim rejections.
For prescribers, this change eliminates unnecessary prior authorization requests unless the generic is medically necessary due to allergies, supply shortages, or better therapeutic outcomes. For pharmacists, it streamlines billing while ensuring patients access the most cost-effective treatment.
As healthcare costs continue to rise, MSSNY encourages physicians to remain informed about NYRx program changes that directly impact prescribing practices and patient affordability. These updates are vital to safeguarding both patient access and practice efficiency.
👉 Learn more about the NYRx BLTG Program and access the full drug list here
