NY Law 273: Preferred Drug Program Prior Authorization

Flashcards covering the requirements, criteria, and procedures for prior authorization under New York Law 273.

A prescription drug is considered to be not on the preferred drug list if it is a __________.

non preferred drug

The preferred drug program must provide a __________ per day, seven days per week telephone call center.

twenty-four hour

A prescriber seeking prior authorization must consult with the program call line to reasonably present their __________ for the prescription.

justification

Approval for a non-preferred drug may be granted if the patient has tried the preferred drug and experienced __________ side effects.

unacceptable

A prescriber may obtain approval if the patient has been stabilized on a non-preferred drug and transition to the preferred drug would be __________

medically contraindicated

The drug utilization review board considers the medical needs of special populations, including those affected by __________, pregnant persons, and persons with an opioid use disorder.

HIV/AIDS

If a prior authorization determination is not completed within twenty-four hours solely due to a failure of the program, it shall be __________ granted.

immediately and automatically

If a prior authorization determination is not completed within twenty-four hours for reasons other than program failure, a __________ supply shall be approved.

seventy-two hour

When a prescriber or pharmacist notifies the program that an emergency condition exists, a __________ emergency supply shall be authorized.

seventy-two hour

Once prior authorization of a prescription for a non-preferred drug is obtained, it shall not be required for any __________ of the prescription.

refill

Prior authorization shall not be required for any __________ products, methadone, or long acting injectable naltrexone for detoxification or maintenance treatment of a substance use disorder.

buprenorphine

The department monitors prior authorization for prescribing patterns that demonstrate a likelihood of __________ or abuse.

fraud

If, after consultation, the prescriber determines that the use of a non-preferred drug is warranted, the prescriber's determination shall be __________.

final

The department shall not require prior authorization for opioid dependence agents on the statewide formulary unless required by the drug use review program under section __________ of the Social Security Act.

$$1927(g)$$

Certain provisions regarding the statewide formulary of opioid dependence agents are deemed repealed on March 31, __________.

$$2026$$