All Stakeholders Call – Medicaid Pharmacy Benefit Transition 8/16

August 9, 2022

As you may recall, the State Fiscal Year (SFY) 2021-22 enacted budget delayed the transition of the Medicaid Pharmacy benefit to the Medicaid Fee-for-Service (FFS) Pharmacy Program by two years, until April 1, 2023.  After this date, and assuming there is no further delay, Medicaid members enrolled in Managed Care (MC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy benefits through the Medicaid Fee-For-Service (FFS) Pharmacy Program instead of through their Medicaid MC Plan.  This is what is known as a reverse carve out.  It means that members of managed care plans will access their drugs outside their plan, unlike the rest of their medical care, which is accessed from in-network providers.  O ver the years there has been significant advocacy by various groups working together to compel New York to revisit this decision, however, the implementation date is fast approaching and the state has begin its’ work to educate stakeholders. 

The transition will include covered outpatient drugs and other products covered under the Outpatient Pharmacy Program. This includes outpatient prescription and over-the-counter drugs, diabetic, incontinence and other supplies. It does not include physician administered (J-Code) drugs. More information regarding what drugs and products are included in the Outpatient Pharmacy Program can be found at the following link.

Additional information can be found here:

We will have more information in the days to come.  For now, we suggest you plan to attend the upcoming Webinar (discussed below).

———- Forwarded message ———
From: <>
Date: Tue, Aug 9, 2022 at 11:20 AM
Subject: All Stakeholders Call – Medicaid Pharmacy Benefit Transition 8/16
To: <>

Dear MRT Listserv Subscriber:

The New York State Department of Health (DOH) is hosting an informational webinar about the transition of the Medicaid Pharmacy benefit from Managed Care to the fee-for-service (FFS) program. This is the first of a series of recurring monthly webinars about this topic, which are open to all interested MRT stakeholders. There will be a designated question and answer period at the end of the webinar.

The All Stakeholders Call – Medicaid Pharmacy Benefit Transition webinar will be held on TuesdayAugust 16, 2022 from 1:00 PM to 2:00 PM.  Following the webinar, the presentation will be posted to the DOH website. 

Please complete the registration form. Registration is required to attend this webinar. After registering, you will receive a confirmation email with information about joining the webinar.

Please plan to join the webinar 5 minutes ahead of the start time. This will reduce wait times getting into the webinar and allow for a prompt start.