Four axes from current statute and agency guidance. Teal bar = substitution/assistance/access in place; amber = permissive or absent.
| Generic substitution mandate | Mandatory by statute |
| State Pharmaceutical Assistance Program | EPIC (Elderly Pharmaceutical Insurance Coverage) |
| 90-day fills permitted | Allowed |
| PMP mandatory prescriber query | Required by statute |
New York mandates generic substitution. Under New York Education Law § 6816-a, a pharmacist shall substitute a less expensive FDA-approved generic equivalent unless the prescriber has written "d a w" (dispense as written) or "brand necessary" in the prescriber's own handwriting on the face of the prescription. The substituted drug must be on the New York State Drug Formulary maintained by the Department of Health.
The New York Medicaid Preferred Drug Program maintains the state PDL and clinical criteria. The state transitioned the pharmacy benefit from managed-care back to fee-for-service under NYRx on April 1, 2023, centralizing pharmacy claims for most Medicaid members. Non-preferred drugs and drugs subject to clinical criteria require prior authorization from the prescriber.
Preferred Drug List: View current PDL
Prior authorization contact: NY Medicaid Pharmacy PA: 1-877-309-9493
New York operates EPIC (Elderly Pharmaceutical Insurance Coverage), one of the largest and most generous SPAPs in the country. EPIC wraps around Medicare Part D for NY seniors 65+, paying Part D premiums for the lowest-income tier (Fee Plan), reducing copays, and covering many drugs in the Part D coverage gap. EPIC is Medicare-recognized, meaning enrollment counts as creditable coverage and EPIC payments count toward True Out-of-Pocket (TrOOP) costs.
Eligibility: Age 65+, NY resident, enrolled in or eligible for Medicare Part D. Income up to $75,000/year (single) or $100,000/year (married).
New York permits 90-day fills of non-controlled chronic medications at retail and mail-order pharmacies. Mail-order pharmacies serving NY patients must be registered as Nonresident Establishments with the NY State Education Department. The state's I-STOP law (Internet System for Tracking Over-Prescribing) requires e-prescribing for all prescriptions including controlled substances since 2016, with limited exceptions for technical failure.
New York's PMP, branded as the Prescription Monitoring Program Registry under the I-STOP law, requires prescribers to consult the registry before prescribing any Schedule II, III, or IV controlled substance. Pharmacists must report dispensing within 24 hours. Dispensers may also consult the registry voluntarily on any patient.
PMP portal: I-STOP / Prescription Monitoring Program Registry
New York has a dense 340B covered-entity network including NYC-area DSH hospitals (NYC Health + Hospitals, Mount Sinai, Montefiore), Ryan White HIV/AIDS clinics, and FQHCs throughout the state. Uninsured and under-insured New Yorkers may access 340B-priced drugs by establishing care at a participating covered entity. Use the HRSA OPAIS database filtered to New York.
Find a 340B clinic in New York: HRSA OPAIS database (NY filter)
Our sister site OmniRx maintains a federal-side patient assistance program directory covering manufacturer PAPs, foundation copay assistance, GoodRx-style discount cards, and 340B locators applicable nationwide.
Once the law side is clear, the next question is which pharmacy actually has the cheapest fill. Use the RxGrab Pharmacy Finder to compare CostPlus Drugs, Costco, Walmart, Amazon Pharmacy, and other discount pharmacies on your specific medication, and read our generic vs brand explainer for the bioequivalence rules behind every substitution.
Under NY Education Law § 6816-a, the pharmacist must substitute an FDA-approved generic equivalent on the NY Drug Formulary unless the prescriber wrote "d a w" or "brand necessary" in their own handwriting. You can ask the pharmacist about brand alternatives at the counter.
EPIC (Elderly Pharmaceutical Insurance Coverage) is New York's SPAP for residents 65+ enrolled in or eligible for Medicare Part D, with income up to $75,000 (single) or $100,000 (married). It wraps Part D, paying premiums for lower-income enrollees and reducing copays. Apply at health.ny.gov/epic.
On April 1, 2023, New York moved the Medicaid pharmacy benefit out of managed-care plans and back to fee-for-service under the NYRx program. This centralized claims processing through eMedNY/FHSC for most members.
Yes since 2016 under I-STOP, including for controlled substances, with very limited exceptions for system failure or specific clinical scenarios.