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NYS Medicaid Pharmacy Programs

Phosphodiesterase type-5 (PDE-5) Inhibitors for PAH

Phosphodiesterase type-5 (PDE-5) Inhibitors for PAH

Prior Authorization Call Line: 1-877-309-9493

Prior Authorization Fax Line: 1-800-268-2990

Prior authorization is required for PDE-5 Inhibitors to ensure appropriate utilization that is consistent with approved indications. Requests for prior authorization can be initiated by either prescribers or their authorized agents. An authorized agent is an employee of the prescribing practitioner and has access to the patient's medical records (i.e. nurse, medical assistant).

Prior authorization requirements:

  • Prescribers are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing this drug.
  • Please be prepared to fax clinical documentation upon request.
  • Prescriptions can be written for a 30-day supply with up to 5 refills.

The CDRP Phosphodiesterase type-5 (PDE-5) Inhibitors for PAH Prescriber Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.