Update: Pharmacy Communication

Dear Medicaid Pharmacy Provider:

To meet the savings target of the Medicaid Redesign Team, the 2011-12 State budget (Chapter 59 of the Laws of 2011) requires a 2% across-the-board reduction to Medicaid payments. The payment reductions are applicable for dates of service on or after April 1, 2011 and remain in effect for dates of service through March 31, 2013.

Each Medicaid sector was given the flexibility to substitute other initiatives to recover all or a portion of the across-the-board reduction. As a result, for SFY 11/12 the State will apply a 0.33% reduction for pharmacy payments. For SFY 12/13, the State intends to once again reduce the required 2% ATB reduction through savings realized from non-MRT pharmacy initiatives. The exact amount of the reduction for SFY 12/13 will be announced prior to the issuance of SFY 12/13 remittance checks.

You will see the 0.33% decrease reflected on the Medicaid check or EFT beginning with Cycle 1786 (check date 11/14/2011 with a release date of 11/30/2011).

The Department will recover the retroactive reduction in a manner similar to the one used to recover the AWP and dispensing fee reduction:

  • Total paid to each pharmacy for service dates 4/1/2011 through 11/2/11 will be identified.
  • That amount will be reduced by 0.33%.
  • A total amount to be recovered will be identified for each pharmacy; and
  • The total amount will be divided evenly by the number of remittances remaining through the end of the State fiscal year.
  • Retroactive reductions will appear on your remittance statement with the code 'ATB' which is defined as across-the-board.

Questions should be submitted to the following electronic mailbox: 2PercentAcrosstheBoard@health.state.ny.us. Be sure to include your provider name and Medicaid number on the email so that questions may be reviewed accordingly. Please keep in mind that individual questions will not be answered but responses to frequently asked questions will be posted to the Department's website.