Magellan logo

Home | Site Map | Contact Us

NYS Medicaid Pharmacy Prior Authorization Programs

Providers • CDRP • Drugs • FAQs

Clinical Drug Review Program Frequently Asked Questions

Listed below are some of the most commonly asked questions about the Clinical Drug Review Program (CDRP). If you do not find the information you need, please submit your question using the Contact Us form.

Program FAQs

Prior Authorization FAQs

General FAQs


Program FAQs

What is the Medicaid CDRP?

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

Back to Top

How is the CDRP established?

Drugs that are managed by the CDRP are reviewed by the State to determine inclusion into the CDRP. The NYS Drug Utilization Review Board (DURB) makes clinical recommendations to the State on which drug(s) should be considered and what the criteria should be for obtaining a drug. The Commissioner of Health issues final determinations based on the recommendations of the DURB.

Back to Top

What is the make-up of the NYS Medicaid Drug Utilization Review Board (DURB)?

The DURB is comprised of health care professionals appointed by the Commissioner and includes physicians and pharmacists that actively practice in New York.

Back to Top

How often does the DUR Board meet?

The schedule for the DURB varies. Dates of the meetings and Agendas are listed on the DUR website. For meeting information, visit http://www.health.ny.gov/health_care/medicaid/program/dur/index.htm

Back to Top

How are providers updated about changes on the CRDP?

All changes to the New York Medicaid CDRP will be communicated to providers via the monthly Medicaid Update publications. If you would like to receive e-mail notifications click here. Providers may also receive targeted letters about specific drugs. Providers should also check the PDP website.

Back to Top

Prior Authorization FAQs

What drugs are subject to the CDRP?

The following drugs are currently subject to this program:

Back to Top

What PDP drug classes are subject to the CDRP?

The following PDP drug classes are subject to this program:

Back to Top

How do I obtain prior authorization for CDRP drugs?

Prior authorization for some CDRP drugs must be obtained by speaking with a representative at the clinical call center.

Back to Top

Who can request a prior authorization?

Some of the drugs subject to the CDRP require that prescribers, not their authorized agents, 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).

Back to Top

When I choose to prescribe a drug managed by the CDRP, how do I obtain prior authorization?

All prior authorization requests should be directed to the prior authorization clinical call center at 1-877-309-9493. In some cases, the prescriber will need to make the call, not their authorized agent. An authorized agent is an employee of the prescribing practitioner and has access to the patient's medical records (i.e. nurse, medical assistant).

Back to Top

What are the hours at the clinical call center?

The clinical call center operates 24 hours per day, 7 days per week.

Back to Top

Which drugs managed by the CDRP require that the prescriber initiate the prior authorization process?

The following drugs require that the prescriber initiate the prior authorization process:

  • Adcirca®
  • Growth Hormones (for enrollees 21 years of age or older)
  • Revatio
  • Serostim®
  • Sivextro®
  • Synagis®
  • Xyrem®
  • Zyvox®

Back to Top

What questions will I be asked?

When calling the clinical call center, a pharmacy technician or pharmacist will ask for specific clinical information. The drug-specific clinical criteria and questions are available at https://newyork.fhsc.com/providers/CDRP_forms.asp.

Back to Top

Will documentation be required?

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. Clinical guidelines for the CDRP as well as prior authorization worksheets are available online at http://newyork.fhsc.com/providers/CDRP_forms.asp.

Back to Top

Once a prior authorization is approved, how long is it valid for?

Prior Authorizations are valid for varying timeframes dependent upon the specific drug and drug utilization review edits implemented.

Back to Top

General FAQs

How do I know which of my patients are subject to the CDRP?

All enrollees who receive pharmacy services through the Medicaid fee-for-service program are subject to the CDRP.

Back to Top