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NYS Medicaid Pharmacy Prior Authorization Programs

Providers • CDRP • Drugs • somatropin (Serostim®)

somatropin (Serostim®)

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

Prior authorization for somatropin (Serostim®) is required to assure medical necessity and to deter the potential of, or history of, drug diversion or illegal utilization. Only prescribers, not their authorized agents, can initiate the prior authorization process for Serostim®. An authorized agent is an employee of the prescribing practitioner and has access to the patient's medical records (i.e. nurse, medical assistant). Fax requests are not permitted.

The following is general information about Serostim® prior authorization requirements:

  • All prescriptions for Serostim® must be prior authorized effective January 15, 2002.
  • Prescribers are required to call the toll free telephone number 1-877-309-9493 and 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 are limited to a maximum of a 28-day supply. Continuation beyond 28 days of therapy will require a new prescription and a new prior authorization number.
  • No refills for Serostim® are allowed. To continue treatment, the patient must be re-examined and a positive therapeutic response documented. If a determination to continue Serostim® therapy is made, the prescriber must write a new prescription and obtain a new prior authorization number.
  • If a patient has received a prior authorization for Serostim® recently, the prescriber will be informed of that issuance date. A new prior authorization for Serostim® should not be issued unless 75% of the previously authorized product has been used as determined by the previous issuance date.
  • The clinical call center will inform prescribers if a patient has received three prior authorizations. The manufacturer's product information/package insert states "no significant additional efficacy was observed beyond 12 weeks". If a prescriber determines that continuation of Serostim® beyond 12 weeks/three prior authorizations is medically necessary, validating documentation must be available for review by the Department when requested.
  • The CDRP somatropin (Serostim®) Prescriber Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.