NYRx, the Medicaid Pharmacy Program

Practitioner Administered Drugs (PAD)

About

Practitioner Administered Drugs (PADs) are covered outpatient drugs administered in the practitioner’s office or other outpatient clinical setting. Beginning in November 2026, NYRx, the Medicaid Drug Program, will be implementing prior authorization (PA) using an iterative, phased approach for select PADs for members with Fee-For-Service (FFS) medical coverage. This effort will create parity for clinical editing and utilization management across the NYRx Medicaid Drug Programs. Each phase, along with the impacted drugs and clinical criteria, will be announced and shared proactively to ensure a smooth transition for FFS providers.

In addition, the pricing benchmarks used to determine the maximum reimbursable amount for drugs in this setting will be changing. Further communications, including effective dates, resources, and educational events, will be coming soon.

For questions about Practitioner Administered Drugs, or support with how to submit a PA, please contact the NYRx Education & Outreach team by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 AM to 5:00 PM ET, Monday through Friday, excluding holidays.

Practitioner Administered Drugs (PAD) Updates

Date
Prior Authorization Request Forms Page