NYS Medicaid Pharmacy Prior Authorization Programs

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Latest News

January 2018
Changes to Medicaid FFS Pharmacy Reimbursement To Be Implemented February 22, 2018
https://www.health.ny.gov/health_care/medicaid/program/update/2018/2018-01.htm#reimburse

January 2018
Medicaid FFS Pharmacy Change in Early Fill Edit for Controlled Substances
https://www.health.ny.gov/health_care/medicaid/program/update/2018/2018-01.htm#earlyfill

November 2017
Authorized Agents for Prior Authorizations of Prescription Drugs
https://www.health.ny.gov/health_care/medicaid/program/update/2017/2017-11.htm#pa

Medicaid Preferred Drug Program

Please review recent changes to the Brand Less Than Generic Program.
Please review recent changes to the fee-for-service pharmacy program which are the result of recommendations made by the Drug Utilization Review Board (DURB).
Please review recent changes to the dose optimization initiative.

Welcome to the NYS Medicaid Pharmacy Prior Authorization Programs Web site.

The Preferred Drug List also includes links to the DUR program web site for drugs/drug classes within the Preferred Drug Program that are affected by step therapy and F/Q/D requirements.

List of Preferred and Non-Preferred Drugs
Prior Authorization forms
Single State Supplemental Rebate Agreements (SRAs) for Preferred Anti-Retrovirals (ARVs)
SMAC Information

Review information related to updated NYS Medicaid Drug Utilization Review Board recommendations.

Read about information regarding initiating prior authorization requests using a web-based application, PAXpress.

The Preferred Diabetic Supply Program (PDSP) covers blood glucose monitors and test strips through the use of a preferred supply list (PSL). Review recent changes to the program.

Services Available

To obtain a prior authorization call 1-877-309-9493.
Sign up to receive e-mail notifications on New York Medicaid PDL changes.
A revised Enrollee Brochure in a number of different languages is available for download. Or, if you would like to place a brochure order, contact us.

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