Changes coming to Medicaid prescription drug program

ROCHESTER, N.Y. – Big changes are coming to the way prescription drugs are purchased on behalf of Medicaid patients in New York. 

The new state budget proposal implements a delayed transition to a new program in which the state takes over prescription purchasing. Governor Hochul’s office says it will create efficiencies, decrease administrative burdens, and reduce confusion for Medicaid recipients.

While there has been push from community health centers to stop the changes from going into effect, the reality is they are set to start on Saturday. At the moment it looks like the state is still planning to move forward with the implementation. 

The NYRx plan will allow Medicaid patients to visit a much wider array of pharmacies to pick up their prescriptions because it essentially eliminates the “middle men”—the pharmacy benefit managers that control which pharmacies get what drugs and for how much.

The new plan is also designed to give the NYS Department of Health more power to negotiate with pharmaceutical companies. The Governor’s office says that will result in bigger rebates on drug prices that could save the state hundreds of millions of dollars.

Medicaid enrollees don’t really have to do anything different at this point.

“They don’t need to re-enroll, they won’t be receiving new cards,” explains Heather Ferrares, the President of the Pharmacists Society of the State of New York. “There is some text messaging that has gone out from NYS to the recipients and most of them have also received an actual physical letter as well but that’s just information.”

The changes are set to go into effect on Saturday.