NYS Medicaid Pharmacy Prior Authorization Programs

Pharmacy Update

For more information on new legislation enacted to help combat the NYS heroin epidemic see the following Medicaid Update articles:

July 2016
New Legislation Enacted to Limit Initial Opioid Prescribing to a Seven Day Supply for Acute Pain p.6
http://www.health.ny.gov/health_care/medicaid/program/update/2016/jul16_mu.pdf

August 2016
New Legislation Enacted for Drugs Used for Detoxification or Maintenance Treatment of Opioid Addiction for Medicaid Fee-for-Service & Medicaid Managed Care Beneficiaries p.24
http://www.health.ny.gov/health_care/medicaid/program/update/2016/aug16_mu.pdf

December 2016
New Legislation Regarding Emergency 5-Day Supply of Drugs used to Treat Substance Use Disorders in Medicaid Fee-for-Service (FFS) & Medicaid Managed Care p.4
http://www.health.ny.gov/health_care/medicaid/program/update/2016/dec16_mu.pdf

This legislation can be found on the NYS legislature website law section under Insurance law section 3216, 3221 and 4303. Social Service Law section 365j. Public Health Law section 273, 3331.
http://public.leginfo.state.ny.us/lawssrch.cgi?NVLWO:

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.

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.