IMPORTANT: On August 28, 2022, Governor Hochul issued Executive Order No 4.12, which terminated the suspension of utilization review for hospitals. Preauthorization and review requirements for the following resume August 29, 2022: scheduled surgeries in hospital facilities, hospital admissions, hospital outpatient services, home health care services following a hospital admission, inpatient and outpatient rehabilitation services following a hospital admission, concurrent review for inpatient and outpatient hospital services and retrospective review for inpatient and outpatient hospital services at in-network hospitals. For additional information, please refer to Supplement No. 1 to Insurance Letter No. 9 (2021).
Prescription Drugs
To assure our members have access to safe, effective drug therapy, and to protect against inappropriate use and waste, prior authorization and step therapy are required on select prescription medications.
Ways to Request Approval
Online with Electronic Prior Authorization (ePA)
A Prior Authorization Determination can be requested directly through your electronic medical record (EMR) system or through the CoverMyMeds ePA Portal. CoverMyMeds ePA is free and can be used by any authorized personnel. Requests can be submitted for prior authorization and renewed 60 days prior to expiration.
Need help? Call the Pharmacy Help Desk at 1-800-724-5033
By eForm
Send a Prescription Drug Coverage Request via secure eForm
By Fax
View and download Prior Authorization Request Forms to submit via fax
Prior Authorization & Step Therapy Requirements
- Commercial 3-Tier Prior Authorization and Step Therapy Medication ListOpen a PDF
- Child Health Plus Prior Authorization and Step Therapy Medication ListOpen a PDF
- Medicaid Managed Care Prior Authorization and Step Therapy Medication ListOpen a PDF
- Specialty Rx Medication List (Self-Administered Drugs)Open a PDF
