NYS Medicaid Pharmacy Prior Authorization Programs
For more information on new legislation enacted to help combat the NYS heroin epidemic see the following Medicaid Update articles:
New Legislation Enacted to Limit Initial Opioid Prescribing to a Seven Day Supply for Acute Pain p.6
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
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
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.
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.
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.