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NYS Medicaid Pharmacy Prior Authorization Programs

Providers • CDRP • Worksheets

• Providers
  • Brand Less Than Generic Program (BLTGP)
  • Clinical Drug Review Program (CDRP)
    • Drugs
      • About
      • becaplermin gel (Regranex®)
      • emtricitabine/tenofovir disoproxil fumarate (Truvada®)
      • fentanyl mucosal agents
      • lidocaine patch (Lidoderm®)
      • oxazolidinone antibiotics (Sivextro®, Zyvox®)
      • palivizumab (Synagis®)
      • sodium oxybate (Xyrem®)
      • somatropin (Serostim®)
    • Frequently Asked Questions (FAQ)
    • PDP Classes subject to CDRP
      • About
      • Anabolic Steroids
      • CNS Stimulants
      • Growth Hormones
      • Phosphodiesterase type-5 (PDE-5) Inhibitors for PAH
      • Topical Immunomodulators
    • Provider Notifications
    • Worksheets
  • Mandatory Generic Drug Program
    • About
    • Frequently Asked Questions (FAQ)
    • Worksheets
  • Preferred Diabetic Supply Program
  • Preferred Drug Program (PDP)
    • About the Program
    • Drug Utilization Review Board (DURB)
    • Forms and Worksheets
    • FAQs - Medical Residents
    • FAQs - Providers & Prescribers
    • Preferred Drug List
    • Provider Notifications
  • Presentations
  • Prior Authorization Programs
    • Forms and Worksheets
  • SMAC Information
• Enrollees
  • Brochures
  • Clinical Drug Review Program (CDRP)
    • Drugs
      • About
    • PDP Classes subject to CDRP
      • About
  • Mandatory Generic Drug Program
    • About the Program
    • Brochures
  • Preferred Drug Program (PDP)
    • About the Program
    • Brochures
    • Frequently Asked Questions (FAQ)
    • Preguntas Frecuentes
• Quick Links
  • DOH Medicaid Update Index
  • Drug Utilization Review Board (DURB)
  • eMedNY formulary file
  • PAXpress
  • PDP/CDRP Annual Reports
  • Preferred Drug List (PDL)

Worksheets