ALBANY- The long-awaited transition to the NYRx pharmacy fee-for-service model that enables Medicaid recipients to access more prescription medications with fewer restrictions has gone into effect on April 1st.
Pharmacists and Medicaid recipients are relieved, after recent concerns about whether or not the transition would be implemented after it had been delayed for nearly two years.
Under the previous 340B reimbursement model, the state contracted through pharmacy benefit managers to negotiate drug pricing. Many, including independent pharmacists from the region, were critical of this reimbursement model claiming it lacked proper transparency and oversight and allowed a select few companies to set prices.
Pharmacists like Al Squitieri from Slate Hill and Mark Freitas from Washingtonville are applauding the change. The men indicated that under the previous reimbursement model, they and other pharmacists were often left filling prescriptions for rates below one dollar. They noted the recent closure of several independent pharmacies in the region and feared that without this change, more closures would take place.
“The transition to NYRx today is in the best interest of those New Yorkers relying on Medicaid for affordable prescription medication,” said Governor Kathy Hochul. “In addition to expanding coverage and access through this program, we are also committing hundreds of millions of additional Medicaid dollars to reinvest in critical providers, including Ryan White programs and Federally Qualified Health Centers, to ensure this change is seamless and has positive impacts across our state.”
According to the governor, under the NYRx model, the state ‘s Medicaid program will pay pharmacy costs directly, eliminating the need for managed care organizations to administer this benefit through pharmacy benefit managers. The new process creates transparency in reimbursements to pharmacies, leverages the state’s purchasing power to negotiate with drug manufacturers, and streamlines administration for practitioners.
The changes also mean improvements for individuals who receive Medicaid. NYRx opens access to a statewide network of over 5,000 pharmacies and at long last, establishes one comprehensive list of the brand-name and generic medications covered under the program.
State Senator James Skoufis (D, Cornwall) has long supported the transition to NYRx and previously sponsored the legislation for fee-for-service pharmacy reimbursement. “Under NYRx, our taxpayers, providers, and independent pharmacies will finally receive the Medicaid network they’ve long deserved. The previous system was financially unsustainable and inherently unjust to our healthcare professionals on our community’s front lines – and the savings generated by this new carveout will be directly reinvested into our hospitals and health centers to ensure the strongest possible transition. This move is a win for everyone involved except the drug company middlemen who will no longer be able to rip off the state’s taxpayers, patients, and providers,” said Skoufis.
Pharmacists Society of the State of New York President Heather Ferrarese said, “The shift to NYRx today will greatly enhance patient access to lifesaving medications and other pharmacy services in both rural and urban areas across the state. It will increase transparency, and Medicaid patients will have one expansive drug formulary and access to one of the largest pharmacy networks in the country so they can use their pharmacy of choice. For New York’s eight million Medicaid patients, NYRx is the right prescription to meet their pharmacy care needs.”
