Drugs Covered by NYRx for Dual Eligible Members Effective 10/22/2020

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Prescription Drugs

The NYRx program provides prescription drug coverage only for the drugs listed below for members who are also enrolled in a Medicare Part D drug plan and Medicare Advantage Drug Contracting (MAPD) plans. All other prescription medications should be reimbursed through the Part D plan. For the most up to date coverage information for the products below, providers should refer to the NYRx List of Reimbursable Drugs.

Prescription Drugs covered for dual eligible beneficiaries:

  • Vitamins
    • Folic acid - oral
    • Hydroxocobalamin - injection
    • Vitamin B12 - injection/nasal
    • Vitamin D2 - oral
    • Vitamin K - oral
  • Cough and Cold
    • Benzonatate

NYRx does not provide dual eligible members with coverage of compounded prescriptions.

The links below provide more information on drug coverage under Medicare Part B and D:

Over-the-Counter Drugs

NYRx covers certain OTC drugs for dual eligible members, if coverage is not available under Medicare. Only NYRx reimbursable drugs excluded by Medicare law are covered for dual eligible members. Therefore, NYRx does not cover OTC insulin and some OTC products which have legend drug substitutes that are covered by Medicare Part D and MAPD plans.

All OTC products covered by NYRx with a prescription or fiscal order can be found using the drug search tool. Please note search results may include OTC products in the excluded categories listed above that are not covered for dual eligible members.