NYS Medicaid Pharmacy Prior Authorization Programs

Pharmacy Update

As has been reported in previous Medicaid Updates (April 2011 and June 2012), provisions of the Affordable Care Act (ACA) require prescribers to be enrolled in state Medicaid programs to be eligible to order or refer services reimbursed by the fee-for service (FFS) Medicaid program. This means that any practitioner not currently enrolled in NYS Medicaid must do so to continue to order or refer services for FFS beneficiaries. Read more.

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 fee-for-service pharmacy program which are the result of 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.

Entire List of Preferred and Non-Preferred Drugs
Prior Authorization forms
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.