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NYS Medicaid Pharmacy Prior Authorization Programs

oxazolidinone antibiotics (Sivextro®, Zyvox®)

oxazolidinone antibiotics (Sivextro®, Zyvox®)

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

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

Prior authorization for oxazolidinone antibiotics (Sivextro®, Zyvox®) has been implemented to address potential misutilization and inappropriate prescribing, which could result in bacterial resistance adversely affecting the health of all New Yorkers. Only prescribers, not their authorized agents, can initiate the prior authorization process for the oxazolidinone antibiotics listed below.

  • linezolid (Zyvox®)
  • tedizolid (Sivextro®)

Prior authorization requirements:

  • Prescribers are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing this drug.
  • Please be prepared to fax clinical documentation upon request.
  • Prescriptions for Zyvox® are limited to a maximum of a 28 tablets, 840 ml of suspension, or 8400 ml of intravenous solution for a 14-day supply. Prescriptions for Sivextro® are limited to a maximum of 6 tablets for a 6-day supply. Continuation beyond these supplies of therapy will require a new prescription and a new prior authorization.
  • No refills for oxazolidinone antibiotic prescriptions are allowed. If additional oxazolidinone antibiotic is needed, the prescriber must write a new prescription and obtain a new prior authorization.
  • The CDRP oxazolidinone antibiotics Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.