Transition (Carve-Out) of Pharmacy Benefit from Managed Care to Fee-For-Service (FFS)

All Stakeholder: Implementation Update

  • Presentation also available in Portable Document Format (PDF)
March 25, 2021


Key Deliverables and Timeline Update
Deliverable(s) Target Date
Complete Work Plan and Establish State Transition Team and 340B Advisory Group June 2020 ✔️
Recurring Workgroup Calls with Health Plans and All Stakeholders begin July 2020 ✔️
Frequently Asked Questions Posted to the NYS DOH Website August 2020 ✔️
Finalize NYS DOH/Managed Care Plan Roles and Scope of Benefits September 2020 ✔️
Consensus between the state and plans on data sharing concept October 2020 ✔️
Deliver file formats, data dictionary, and process for daily claim file November 2020 ✔️
Transition Analysis Conducted (e.g., Formulary, DME, OTC Comparisons), Changes Made To Smooth Transition and Transition Strategy Finalized November 2020 ✔️
Identify Sections of the Model Contract that Require Changes December 2020 ✔️
Notice of 1115 Waiver Amendment December 2020 ✔️
Required System Changes Identified December 2020 ✔️
Initial Special Edition Medicaid Update Published December 2020 ✔️
Systems Stress Testing Performed to Verify Volume Handling January 2021 ✔️
Customer Service Staff Hired and Trained February 2021 ✔️
Second Special Edition Medicaid Update Published March 2021 ✔️
1115 Waiver Renewal Application Accepted by CMS March 2021 ✔️
Member Notifice of Change and Non-Enrolled Provider Notifications Sent March 2021
Make Required Changes to Common Benefit Identification card (CBIC) Carrier or Notice May 2021
Required System Changes Implemented By May 1, 2021
Go Live May 1, 2021
340B Related State Plan Amendment (SPA) Submitted June 2021

Website Updates

Website updates will continue to be communicated via the MRT LISTSERV.


Information regarding the transition of the pharmacy benefit from Managed Care to FFS will be posted at the above website.

Email: – Please write Carve-Out in the subject line

DOH Medicaid Update:



Please submit your question to All Panelists using the Q&A feature of the WebEx Event meeting.