Medicaid and the Medicare Part D Prescription Drug Benefit

Medicare Part D is a prescription drug benefit available to everyone with Medicare. It has special importance to people with Medicare and New York State Medicaid because Medicare Part D replaces Medicaid in paying for most of your prescription drugs.

Under the Medicare Part D prescription benefit almost all of your drugs costs will be paid for by Medicare instead of Medicaid. You will get prescription drug coverage from Medicare and pay a small Medicare copayment for each prescription. If you currently receive NYS Medicaid and you do not join a Medicare prescription drug plan, you may lose all your NYS Medicaid benefits.

When you become eligible for both Medicare and Medicaid you will automatically be assigned to a Medicare Prescription Drug Plan to make sure you don't miss a day of coverage. You can also enroll in a plan of your own choosing that may better meet your prescription drug needs. Information about available plans and the “Medicare & You” handbook is available from Medicare. Be sure to read this information to understand all the changes.

For more information, click on or call:

  • Medicare
     1-800-MEDICARE
    (1-800-633-4227)
    TTY users should call 1-877-486-2048

Or for free personalized health insurance counseling contact:

Important Information for Prescribers and Pharmacists:

Medicaid will continue to pay for drugs in classes excluded from the Medicare prescription drug benefit. These drugs classes are benzodiazepines, barbiturates, select prescription vitamins and certain non-prescription drugs. In addition, Medicaid will cover the following types of drugs through a limited wrap around benefit only when the enrollee's Part D plan will not pay for them:

  • Atypical antipsychotics
  • Antidepressants
  • Antiretrovirals used in the treatment of HIV/AIDS
  • Immunosuppressants used in the treatment of tissue and organ transplants

However, prescribers are expected to work with their patient's drug plan to obtain coverage under Part D.

All Medicaid rules apply to wrap around benefit claims, including any Medicaid prior authorization requirements and copayment guidelines. If the drug requires prior authorization under Medicaid, the prescriber must complete the Medicaid prior authorization process by calling 1-877-309-9493. The Medicaid wrap around benefit cannot be used to obtain early refills, refills for lost or stolen drugs, extended or vacation supplies.

Additional Information