Beginning November 19, 2026, New York Medicaid Fee-For-Service (FFS) will require prior authorization (PA) for certain practitioner administered drugs (PADs) administered in office, clinic, or outpatient settings. Check the PAD Quick Reference Guide for the list of drugs and drug classes. Prescribers will be required to obtain prior authorization before Medicaid will cover the cost of the drug.

Other options to request prior authorization: use CoverMyMeds, fax the PA form to 1-800-268-2990, or call 1-877-309-9493.

• If you need support obtaining a PA, contact the NYRx Education & Outreach Team at 1-833-967-7310 or NYRxEO@primetherapeutics.com.
• NY Medicaid will send communications about additional PADs and clinical editing.
• Subscribe to the eMedNY listserv and NYRx Education & Outreach Notification Service.

Note: If a practitioner administered drug is not available in PAXpress, then it may not require prior authorization or it may need to follow the “by report” manual review process.