The Centers for Medicare and Medicaid Services (CMS), in compliance with Social Security Law Sec. 1927 [42 U.S.C. §1396r–8(a)], requires drug manufacturers to participate in the Medicaid Drug Rebate Program (MDRP)

However, effective October 20205 some manufacturers willingly withdrew from the program, therefore NYS Medicaid NYRx will no longer cover the following medications/manufacturers.

Please note there is no auth requirement- they are just no longer covered altogether. image via NYS Medicaid NYRx

Affected Medications: image via NYS Medicaid NYRx

January 2026 the following manufacturers also withdrew from the program: image via Healthfirst (affected medications)

Providers should verify medication coverage before prescribing

For patients that are already on any of these medications, providers need to transition the member to another alternative

Find this type of information useful? Follow my blog for more payer updates!

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