Prescription Drug Policies

The following is a list of our prescription drug policies. If you cannot find a policy for a specific medication, please select the link titled 'Clinical Review Prior Authorization' from the list below.

Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Learn more about the transition of the pharmacy benefit from Blue Choice Option, HMO Blue Option, and Blue Option Plus to NYRx, the Medicaid Pharmacy Program.

Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.

Make a Comment

We invite practitioners to review & comment on our policies.

Showing 51– 58 of 58 Results
Title Last Updated
Botulinum Toxin (Botox, Daxxify, Dysport, Myobloc, Xeomin) – For Medicaid Managed Care Essential Plan and Child Health Plus Open a PDF 9/28/2023
Blood Modifiers - (Cosela, Fulphila, Fylnetra, Granix, Neulasta, Neupogen, Nivestym, Nyvepria, Releuko, Rolvedon, Udenyca, Ziextenzo) Open a PDF 07/28/2023
Attention Deficit Hyperactivity Disorder (ADHD) Stimulants - (Adhansia XR, Adzenys ER (amphetamine ER suspension), Adzenys XR ODT (amphetamine ER ODT), Azstarys, Cotempla XR ODT (methylphenidate ER ODT), Daytrana (methylphenidate patch), Desoxyn (methamphetamine), Dyanavel XR (amphetamine ER suspension), Dyanavel XR (methylphenidate patch), Jornay PM (methylphenidate ER capsules), Managed Medicaid members only: (Central Nervous System (CNS) stimulants used in combination with medication assisted treatment (MAT) therapy), Mydayis, Qelbree (viloxazine ER capsules), Quillichew ER (methylphenidate ER chewable tablets), Quillivant (methylphenidate ER suspension), Xelstrym) Open a PDF 4/1/2023
Antihemophilic Agents (For Managed Medicaid and HARP) Open a PDF 07/17/2023
Anti-Amyloid Directed Therapies Policy (Aduhelm (aducanumab-avwa) & Leqembi (lecanemab-irmb)) Open a PDF 9/7/2023
Amyotrophic Lateral Sclerosis (ALS) Policy - (Exservan - riluzole oral film (Rx), Radicava and Radicava ORS - edaravone injection and kit (Rx/Medical), Relyvrio - sodium phenylbutyrate and taurursodiol (Rx), Tiglutik-riluzole oral suspension (Rx), & Qalsody-tofersen (Medical)) Open a PDF 5/30/2023
Alpha-1 Antitrypsin Therapy (AAT) Open a PDF 3/20/2023
Adalimumab (Humira® [adalimumab], Amjevita™ [adalimumab-atto], Cyltezo® [adalimumab-adbm], Hadlima™ [adalimumab-bwwd], Hulio®/adalimumab-fkjp [adalimumab-fkjp], Hyrimoz®/adalimumab-adaz [adalimumab-adaz], Idacio® [adalimumab-aacf], Yuflyma® [adalimumab-aaty], Yusimry™ [adalimumab-aqvh] Open a PDF 9/1/2023
Showing 51– 58 of 58 Results


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