NYS Medicaid Pharmacy Prior Authorization Programs
Enrollees • PDP • FAQs
Preferred Drug Program Frequently Asked Questions - Enrollees
Effective June 28, 2006 the New York State Medicaid program began using a Preferred Drug List (PDL).
- What is the Medicaid PDL?
- What is a preferred drug?
- What if I take a medicine that is not on the preferred drug list?
- What if I need my medication and the doctor's office is closed?
- What if I don't want to change my medications?
- Will I still have a co-pay?
- I now have an MCO instead of Medicaid, where does my prescriber call for an authorization?
What is the Medicaid PDL?
All drugs covered by Medicaid remain available under the Preferred Drug Program. The program encourages doctors to prescribe drugs that are “preferred” because they are safe, effective and less costly. However, when a doctor prescribes a “non-preferred” drug on the PDL, they will need to get special approval through a prior authorization process. The program only affects certain drugs in some drug classes.
What is a preferred drug?
A committee made up of doctors, nurse practitioners, pharmacists, and patient advocates works with the Department of Health to review different drugs and identify those that are safe, effective and less expensive. These drugs are called “preferred” drugs. Other drugs are determined to be “non-preferred”. Your doctor has a listing of preferred and non-preferred drugs available.
What if I take a medicine that is not on the preferred drug list?
Your doctor may decide that the preferred drug is just as effective for you, and recommend changing your medication or request a prior authorization to continue your treatment on the non-preferred drug.
What if I need my medication and the doctor's office is closed?
If your doctor cannot be contacted and you have a valid prescription, the pharmacist can give you a 72-hour emergency supply of medicine until your doctor can be contacted.
What if I don't want to change my medications?
Only your doctor can decide which drugs you should take. Ask your doctor or pharmacist if you have questions about your prescriptions.
Will I still have a co-pay?
Yes, Medicaid co-payments for prescriptions are:
- Preferred brand name prescriptions - $1.00
- Non-Preferred brand drugs - $3.00
- Generic drugs - $1.00
- OTC drugs - $0.50
I now have an MCO instead of Medicaid, where does my prescriber call for an authorization?
Enrollees should have their prescribers contact the MCO regarding the prior authorization process.