Effective October 1, 2021, opioid substance use disorder medication coverage is dictated by the New York State Department of Health Single Statewide Medication Assisted Treatment Formulary. For more information and a list of medications, please visit here.
Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder. Prescriptions written outside of accepted guidelines may be subject to prior authorization. For more information and a list of medications, please visit here.
Prescriptions for a brand name multi-source drug will be filled with a generic equivalent, as required by New York State Social Services and Education Law, unless the Prescriber indicates “Dispense as Written (DAW)”, and “Brand Medically Necessary” on the prescription. The Prescriber must also make a notation in the Medicaid member’s medical record that the drug is “brand medically necessary,” and the reason that a brand name multi-source drug is required.