The NYS Executive Order #4Open a PDF has been extended to May 30, 2022. We will suspend preauthorization requirements for dates of service September 27, 2021 – May 30, 2022 for scheduled hospital surgeries and admissions, hospital outpatient services, home health care services following a hospital admission and inpatient and outpatient rehabilitation services following a hospital admission for fully insured members and self-insured groups that have opted in. Submission of the completed state-approved certification formOpen a PDF is required. Please continue to notify us of all inpatient admissions and discharges to ensure continuity and coordination of care.
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 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
