Dual Eligible Member Notice of Change

  • Notice is also available in Portable Document Format (PDF)

[PLAN TO INSERT BRANDING]

ATTENTION: DUAL ELIGIBLE BENEFICIARIES

(Individuals covered by both Medicare and Medicaid)
CHANGES TO YOUR MEDICAID PHARMACY BENEFITS EFFECTIVE April 1, 2023

This notice tells you about an upcoming change to your Medicaid pharmacy benefit. Please be aware your Medicare Part D pharmacy coverage and pharmacy is not changing. You can also continue to use your Medicare plan's over-the-counter (OTC) card for non-prescription medications and/or other covered items. Please read this notice carefully and save it for future reference.

You can also access this notice here.

PHARMACY BENEFIT CHANGE:

  • Starting April 1, 2023, your Medicaid pharmacy prescriptions will not be covered by [Each Managed Care Plan will insert their Plan name]. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.
  • Most pharmacy prescriptions are covered by your Medicare Part D coverage. You may also use your Medicare plan's OTC card as stated above.
  • If Medicare does not cover a pharmacy prescription and you need to use your Medicaid pharmacy benefit, most pharmacies in New York State take the Medicaid NYRx pharmacy program. If your pharmacy does not take Medicaid, you may:
    • Ask your doctor to send a new prescription to a pharmacy that takes Medicaid NYRx pharmacy program, or
    • Ask your pharmacist to transfer a refill to a pharmacy that takes the Medicaid NYRx pharmacy program.
  • Locate a pharmacy that takes Medicaid NYRx at: https://member.emedny.org/
  • You will need to show the pharmacist your NYS Benefit Card. This will tell them your Client Identification Number (CIN).
    ID Card
    • Your NYS Medicaid Card looks like this, and your CIN is highlighted:
  • Medicaid NYRx pharmacy program has a list of covered drugs. Over-the-counter drugs and most prescription drugs are on the list. This list of covered drugs can be found here.

Do you have questions or need help? The Medicaid Helpline can assist you. They can talk to you in your preferred language. They can be reached at 1-855-648-1909. TTY 1-800-662-1220

They can answer your call:

  • Monday - Friday, 8am – 8pm
  • Saturday, 9am – 1 pm

If you would like to request supporting aids, services, materials, or other information regarding this change in an alternative format or larger print, call the number on your health plan card.