NYS Medicaid PBM Laws

[STAR3URY]

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Does anyone know if the NYS Medicaid PBM follows the same laws as NYS Medicaid did previously, in terms of transferring prescriptions. I have a lot of patients that go down to florida or other states, and want to fill their prescriptions at different CVS but I dont know what to tell them and what the Law is. I know before NYS medicaid did not allow transfer of rx's between pharmacies.

And also, if anyone has a source of where to get all the laws for Medicaid PBM..that would be helpful

thanks

 

[All4MyDaughter]

I've never seen Medicaid work across state lines. 😕

 

[npage148]

Regarding NYS medicaid. You can transfer rx's out and in but you can't use medicaid to bill a transfer. A medicaid pt can transfer all day, but they are going to need to pay out of pocket for the medication.

Also, NYS medicaid will not work out of state nor do they do vacation refills.

 

[STAR3URY]

Regarding NYS medicaid. You can transfer rx's out and in but you can't use medicaid to bill a transfer. A medicaid pt can transfer all day, but they are going to need to pay out of pocket for the medication.

Also, NYS medicaid will not work out of state nor do they do vacation refills.

Yes...but you are referring to the old "NY BENEFIT MEDICAID" these are relatively new PBM medicaid that went into effect in October 2011.

 

[MountainPharmD]

The transfer restrictions on prescriptions is a NY state law. Second I think you are confusing transfering and paying for a prescription out of state. How could New York Medicaid tell someone they cannot transfer a prescription?

 

[npage148]

Ah, I missed that. I really don't know. I would think that it would be ok to transfer with the PBM cards.

On a side note: Soma is a NYS C-IV now!!! so crazy

 

[genesis09]

Ah, I missed that. I really don't know. I would think that it would be ok to transfer with the PBM cards.

On a side note: Soma is a NYS C-IV now!!! so crazy

Soma became a federal controlled substance earlier this year.

 

[Ackj]

The transfer restrictions on prescriptions is a NY state law. Second I think you are confusing transfering and paying for a prescription out of state. How could New York Medicaid tell someone they cannot transfer a prescription?

Being a PBM guy, do you have to deal with multiple state laws now, with tons of different RX coming through you guys? Or does your facility generally just handle local businesses?

 

[All4MyDaughter]

Being a PBM guy, do you have to deal with multiple state laws now, with tons of different RX coming through you guys? Or does your facility generally just handle local businesses?

I think he's a PA review pharmacist, not involved in dispensing.