NYRx, The New Medicaid Pharmacy Program for New York State

Effective April 1, 2023, New York State Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will now receive their pharmacy benefits through NYRx, the Medicaid Pharmacy Program. This change aims to centralize the pharmacy benefit, enhance negotiation power, and simplify the drug benefit for members.

By transitioning to NYRx, New York State can effectively monitor prescription drug costs and offer consistent coverage to all Medicaid members. With a vast network of over 5,000 pharmacy providers, New York State Medicaid members will have equitable access to comprehensive drug coverage.

Streamlining and Automating Prior Authorizations for NYRx

While the prior authorization process for NYRx has been simplified for providers, it currently requires repetitive data entry, manual submission, and constant monitoring for approval and escalation. Fortunately, these error-prone processes can be automated. Digital Blue’s automated prior authorization solution, The DCA, has helped providers save 5-7 minutes of manual effort per NYRx Medicaid Prior Authorization Request.

Benefits to automating NYRx Medicaid Prior Authorization Requests

Benefits to automating NYRX Medicaid prior authorization requests  include:

• Improved Efficiency-  Artificial Intelligence (AI) powered digital workers can process requests quickly and accurately, eliminating the need for manual processing and greatly reducing data entry errors or approval delays. 
• Reduce Cost – The solution drastically reduces staff time by over 60% and can prevent costly mistakes, such as billing errors, incomplete submissions, and duplications.
• Improved Patient Satisfaction- Patients are less likely to experience delays in care, and time to approval is often decreased by 50%. 
• Improved Provider Satisfaction: Providers consistently state that the administrative burden is the #1 reason for burnout. By automating most aspects of prior authorization, providers spend less time on administrative tasks and more time providing patient care.
• Enhanced Compliance: Automating prior authorization can ensure compliance with the new NY state regulatory requirements and payer guidelines. Our solution can identify potential compliance issues and ensure all necessary documentation is included with the request, reducing the risk of denial of claims.

To see how The DCA can simplify your NYRx prior authorization submissions, schedule a demo or email us at DCA@digitalblue.io