120.907 Nuisance Prior Authorizations
Prior authorizations for medication must have a sound clinical justification which would be available upon request from the Pharmacy Benefit Manager and which would include, but not be limited to, promotion of adherence to guidelines, promotion of generic alternatives, and prevention of adverse reactions. MSSNY will advocate with the NYS Department of Health and NYS Department of Financial Services to prevent health insurers from imposing prior authorizations without appropriate clinical justification and to instruct Medicaid managed care contractors to approve prior authorizations for a minimum of one year. (HOD 2019-61)
