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NYS Medicaid Pharmacy Prior Authorization Programs

Providers • CDRP • Drugs • fentanyl mucosal agents

fentanyl mucosal agents

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

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

Prior authorization for fentanyl mucosal agents has been implemented to reinforce appropriate use and to ensure utilization consistent with approved indications. Requests for prior authorization of the below fentanyl mucosal agents 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).

  • fentanyl buccal soluble film (Onsolis® and any generics)
  • fentanyl buccal tablet (Fentora® and any generics)
  • fentanyl lozenge (Actiq® and any generics)
  • fentanyl nasal spray (Lazanda®)
  • fentanyl sublingual spray (Subsys®)
  • fentanyl sublingual tablets (Abstral® and any generics)

The following is general information about the prior authorization requirements:

  • All prescriptions for the above fentanyl mucosal agents must be prior authorized.
  • Prescribers are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing this drug.
  • No refill prescriptions are allowed for fentanyl mucosal agents. If additional medication is needed, the prescriber must write a new prescription and obtain a new prior authorization number.
  • The CDRP fentanyl mucosal agents Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.