NYRx, the Medicaid Pharmacy Program

About

The Clinical Drug Review Program (CDRP) is aimed at ensuring specific drugs are utilized in a medically appropriate manner. Under the CDRP, certain drugs require prior authorization because there may be specific safety issues, public health concerns, the potential for fraud and abuse or the potential for significant overuse and misuse.

Prior Authorization

Prior authorization for some drugs subject to the CDRP must be obtained through a representative at the clinical call center. For some drugs subject to the CDRP, only prescribers, not their authorized agents, can initiate the prior authorization process. An authorized agent is an employee of the prescribing practitioner and has access to the patient's medical records (i.e. nurse, medical assistant).

Each CDRP drug has specific clinical information that must be provided to the clinical call center before prior authorization will be issued. Prescribers may be asked to fax that information. CDRP prior authorization worksheets are available online.

The following drugs are subject to the Clinical Drug Review Program:

• fentanyl mucosal agents
• palivizumab (Synagis®)
• sodium oxybate products (Xyrem®, Xywav™)
• somatropin (Serostim®)

The following Preferred Drug Program Class is subject to the Clinical Drug Review Program prior authorization requirements:

• Anabolic Steroids

For questions and comments:

• Visit https://newyork.fhsc.com/contactus.asp,
• Call Medicaid's pharmacy program at 1-518-486-3209, or
• E-mail NYRx@health.ny.gov (please note "Clinical Drug Review Program" in the subject area).