NYS Medicaid Pharmacy Prior Authorization Programs
Providers • CDRP • Drugs • lidocaine patch (Lidoderm®)
lidocaine patch (Lidoderm®)
Prior Authorization Call Line: 1-877-309-9493
Prior Authorization Fax Line: 1-800-268-2990
Prior authorization for lidocaine patch (Lidoderm®) has been implemented to reinforce appropriate use and to ensure utilization consistent with the approved indication. Requests for prior authorization of Lidoderm® can be initiated by either prescribers or their authorized agents.
The following is general information about Lidoderm® prior authorization requirements:
- All prescriptions for Lidoderm® must be prior authorized effective July 30, 2008.
- Prescribers, or their authorized agents, are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing this drug.
- Prescriptions can be written for a 30-day supply with up to 2 refills.
- The CDRP lidocaine patch (Lidoderm®) Prescriber Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.