Although New York leaders have supported policies protecting patient access to pharmacies, some interests want to hinder in-progress reforms that put Medicaid patients first.

NY is joining other states that have moved or are planning to move prescription drug coverage administration from the hands of pharmacy benefit managers (PBMs) of Managed Care plans back to a Medicaid Fee for Service approach so it can be directly administered by the State.

Known as “NYRx”, this pharmacy benefit expansion builds on last year’s NY-passed legislation to regulate PBMs to address limited networks, varied standards, unjustified costs to both patient and pharmacy, and ultimately, diminished patient care.

These patients-first NYRx reforms will help Medicaid patients by:  

• Opening access to choice of pharmacy or pharmacist to acquire the type of care needed;
• Eliminating limited networks and plan directives that would prevent a rural or urban patient from accessing nearby services;  
• Expanding access to medications, which is especially key for those with chronic diseases like HIV, diabetes, hypertension, hepatitis C; 
• Shifting sub-par drug coverage plans that covers 60-70% of FDA-approved medications to one that covers 100%; 
• Improving health – which lowers healthcare system costs – and re-investing limited Medicaid dollars in patient care; and 
• Stopping the pharmacy-crushing below-cost reimbursement that threatens pharmacies and pharmacy care in communities. 

For 3 years now, the state has been staging its NYRx April 1, 2023 reform and has the operational systems and vendors in place to help ensure a smooth and positive change for Medicaid patients. It is critical New York leaders support and protect these NYRx reforms and ensure its April 1, 2023 launch without changes to the approved plan.

We support NY’s efforts to also identify a permanent solution to insulate New York’s community and pharmacy services access points from federal and other 340B changes as part of this effort.