Prior Authorization for PADs One Sheet

• Prior Authorization for PADs One Sheet (PDF)

Prior Authorization for Practitioner Administered Drugs

Effective November 19, 2026, providers may need to obtain prior authorization (PA) for certain practitioner administered drugs (PADs) before administering them to Medicaid Fee-For-Service (FFS) members. Check the NYRx, Medicaid Drug Program website for FFS policy and guidance, including clinical criteria.

NDC Quantity Required for PA

NDC Quantity: The National Drug Code (NDC) quantity reflects the actual manufacturer-specific product amount (vial/each, milliliter, gram). All PA requests must be submitted using the NDC quantity, including any waste from single-use containers.

For providers billing drugs separately, the PAD Search Tool can help determine the correct HCPCS units and NDC quantity.

How to Obtain PA

• Electronic (recommended)
  PAXpress or CoverMyMeds (CMM)
• Fax the PA form to 1-800-268-2990.
  Requests by fax are responded to within 24 hours.
• Call 1-877-309-9493.
  The NYRx Clinical Call Center is open daily, 24 hours.

Need help?

For support with obtaining a PA, contact the NYRx Education & Outreach Team at 1-833-967-7310 or NYRxEO@primetherapeutics.com. Clinical criteria and other resources are available on the PAD Program webpage.