Prior Authorization Worksheet For Prescribers Clinical Drug Review Program - New York State Medicaid Program
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1
2
3NEW YORK STATE MEDICAID PROGRAM
PRIOR AUTHORIZATION INSTRUCTIONS FOR PRESCRIBERS
CLINICAL DRUG REVIEW PROGRAM
Prior Authorization Call Line 1- 877- 309- 9493
PROGRAM INFORMATION
Drugs included in the Clinical Drug Review Program require prior authorization.
A list of CDRP drugs is available at
and at
Under the CDRP, only the prescriber, not an authorized agent, must call the prior authorization call line to initiate a
prior authorization.
Fax requests are NOT permitted for the Clinical Drug Review Program.
When calling the staffed clinical call center, a pharmacy technician or a pharmacist will ask for specific clinical
information.
PRESCRIBER PROCEDURE
To initiate the prior authorization process, the prescriber must call the prior authorization phone line at
1-877-309-9493 and select Option “1” for Prescriber.
Select Option “1” again to obtain a prior authorization for a CDRP drug. Please be prepared to provide the
following information when calling:
Prescriber’s Medicaid ID number o
r license number
Recipient’s Medica
id ID number
CDRP drug name
Each CDRP drug has specific clinical information that must be provided before a prior authorization will be issued.
The clinical criteria relevant to each specific CDRP drug are listed at the end of the prior authorization worksheet.
If uncertain which selection t
o make or if assistance with the prior authorization process is required, select
Option “3” for assistance.
Once authorization is given and a prior authorization number is obtained, the number must be written on the face o
f
the prescriptio
n. Please be sure to include the “W” when writing the prior authorization number on the patient’s
prescription.
For billing questions, call 1-800-343-9000
For clinic
al concerns o
r Clinical Drug Review Program questions, visit
w
ww.nyhealth.go
v
and
or call 1-877-309-9493
For Medicaid pharmacy policy and operations questions, call (518) 486-3209
Revised 9/06
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