§ 273. Preferred drug program prior authorization. 1. For the purposes\nof this article, a prescription drug shall be considered to be not on\nthe preferred drug list if it is a non preferred drug.\n 2. The preferred drug program shall make available a twenty-four hour\nper day, seven days per week telephone call center that includes a\ntoll-free telephone line and dedicated facsimile line to respond to\nrequests for prior authorization. The call center shall include\nqualified health care professionals who shall be available to consult\nwith prescribers concerning prescription drugs that are not on the\npreferred drug list. A prescriber seeking prior authorization shall\nconsult with the program call line to reasonably present his or her\njustification for the prescription and give the program's qualified\nhealth care professional a reasonable opportunity to respond.\n 3. * (a) When a patient's health care provider prescribes a\nprescription drug that is not on the preferred drug list or the\nstatewide formulary of opioid dependence agents and opioid antagonists\nestablished pursuant to subparagraph (vii) of paragraph (e) of\nsubdivision seven of section three hundred sixty-seven-a of the social\nservices law, the prescriber shall consult with the program to confirm\nthat in his or her reasonable professional judgment, the patient's\nclinical condition is consistent with the criteria for approval of the\nnon-preferred drug. Such criteria shall include:\n (i) the preferred drug has been tried by the patient and has failed to\nproduce the desired health outcomes;\n (ii) the patient has tried the preferred drug and has experienced\nunacceptable side effects;\n (iii) the patient has been stabilized on a non-preferred drug and\ntransition to the preferred drug would be medically contraindicated; or\n (iv) other clinical indications identified by the drug utilization\nreview board established pursuant to section three hundred sixty-nine-bb\nof the social services law, which shall include consideration of the\nmedical needs of special populations, including children, elderly,\nchronically ill, persons with mental health conditions, and persons\naffected by HIV/AIDS, pregnant persons, and persons with an opioid use\ndisorder.\n * NB Effective until March 31, 2026\n * (a) When a patient's health care provider prescribes a prescription\ndrug that is not on the preferred drug list, the prescriber shall\nconsult with the program to confirm that in his or her reasonable\nprofessional judgment, the patient's clinical condition is consistent\nwith the criteria for approval of the non-preferred drug. Such criteria\nshall include:\n (i) the preferred drug has been tried by the patient and has failed to\nproduce the desired health outcomes;\n (ii) the patient has tried the preferred drug and has experienced\nunacceptable side effects;\n (iii) the patient has been stabilized on a non-preferred drug and\ntransition to the preferred drug would be medically contraindicated; or\n (iv) other clinical indications identified by the committee for the\npatient's use of the non-preferred drug, which shall include\nconsideration of the medical needs of special populations, including\nchildren, elderly, chronically ill, persons with mental health\nconditions, and persons affected by HIV/AIDS.\n * NB Effective March 31, 2026\n * (a-1) When a patient's health care provider prescribes a\nprescription drug that is on the statewide formulary of opioid\ndependence agents and opioid antagonists established pursuant to\nsubparagraph (vii) of paragraph (e) of subdivision seven of section\nthree hundred sixty-seven-a of the social services law, the department\nshall not require prior authorization unless required by the\ndepartment's drug use review program established pursuant to section\n1927(g) of the Social Security Act.\n * NB Repealed March 31, 2026\n (b) In the event that the patient does not meet the criteria in\nparagraph (a) of this subdiv
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.