Medicaid Fee-For-Service (FFS) to Systematically Enforce Legislation Limiting Initial Opioid Prescribing to a Seven Day Supply

8/14/2017

In accordance with New York State Public Health Law, effective August 24th, 2017, the Medicaid FFS program will be implementing a seven (7) day supply limit on initial opioid prescribing for acute pain.

This is a change from the current editing, implemented on December 5, 2013, which set the limit to a fifteen (15) day supply on initial opioid prescriptions. Information on this legislation can be found on page 6 of the July 2016 Medicaid Update.

Prior authorization (PA) will be required for claims that do not meet the above criteria.

To obtain a PA, please contact the clinical call center at 1-877-309-9493. The clinical call center is available 24 hours per day, 7 days per week with pharmacy technicians and pharmacists who will work with you, or your agent, to quickly obtain a PA.

The most up-to-date information on the Medicaid FFS Pharmacy Prior Authorization (PA) Programs and a full listing of drugs subject to the Medicaid FFS Pharmacy Programs can be found at: http://newyork.fhsc.com & https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf.

Medicaid enrolled prescribers can also initiate PA requests using a web-based application. PAXpress® is a web based pharmacy PA request/response application accessible through http://www.eMedNY.org