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NYS Medicaid Pharmacy Prior Authorization Programs

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 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)

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.
  • Up to two refills or maximum of 3 month supply are allowed for fentanyl mucosal agents. If additional medication is needed, the prescriber must write a new prescription and obtain a new prior authorization.
  • The Opioid Agents Worksheet can assist in completing the prior authorization process.