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New York Medicaid Prior Authorization Form

A New York Medicaid prior authorization form is used by a healthcare provider to request Medicaid coverage of certain prescription medications. The physician must submit this form when prescribing a non-preferred drug (one not on the state's preferred drug list) to a patient using Medicaid.
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Fax – 1 (800) 268-2990

Phone – 1 (877) 309-9493

Preferred Drug List – Drugs deemed acceptable for prescription by the State