MedicaidAdministrativeMedium impact
Pharmacy Carve-Out Delayed By Two Years
Healthfirst·NY·Pharmacy
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
The Medicaid Pharmacy Carve-Out transition has been delayed by two years until April 1, 2023. The Medicaid pharmacy benefit will remain under Managed Care instead of transitioning to fee-for-service as originally planned.
Action Required
By April 1, 2023: Billing team should continue current Medicaid pharmacy billing procedures through Managed Care plans. Monitor DOH announcements and Pharmacy Carve-Out website for updated transition information. No immediate billing system changes required due to the delay.