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NYS Medicaid Pharmacy Prior Authorization Programs

Providers • CDRP • PDP Classes subject to CDRP • Topical Immunomodulators

Topical Immunomodulators

Prior Authorization Call Line: 1-877-309-9493
Prior Authorization Fax Line: 1-800-268-2990

Prior authorization for Topical Immunomodulators has been implemented to reinforce appropriate use and to ensure utilization consistent with approved indications. Requests for prior authorization of Topical Immunomodulators 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).

The following is general information about Topical Immunomodulators prior authorization requirements:

  • All prescriptions for Topical Immunomodulators must be prior authorized effective October 21, 2009.
  • Prescribers are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing this drug.
  • Five refills for Topical Immunomodulator prescriptions are allowed.
  • The CDRP Topical Immunomodulators Prescriber Worksheet and Instructions provides step-by-step assistance in completing the prior authorization process.