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11/22/2011

Attention: Medicaid Fee-For-Service Providers

Enhancements are being made to the Mandatory Generic Drug Program (MGDP) Prior Authorization (PA) Process.


Effective December 8, 2011, callers will speak directly to a clinical call center representative, rather than using an automated system, to obtain PA for a brand name drug.

To obtain PA for a brand name drug, call (877) 309-9493 and follow the appropriate prompts. Listen carefully to the prompts as they will be updated to reflect this change.

The prescriber, or an authorized agent of the prescriber, will then be required to provide the following information:


•Prescriber’s National Provider Identifier (NPI) Number

•Enrollee’s Identification Number (2 letters, 5 numbers, 1 letter)

•Brand Name Drug


The caller should be prepared to answer the questions below and document the drug name, the reason the brand name drug is being requested, and the prior authorization number in the patient’s medical record.

1. Does the patient have an allergy to generic drug inactive ingredient(s)?

2. Was there an adverse reaction to generic drug inactive ingredient(s)?

3. Is there a documented history of successful therapeutic control with brand name drug and changing to a generic would be contraindicated?

The Prescriber must also write “DAW/Brand Medically Necessary” on the face of the prescription.

For additional information regarding the Mandatory Generic Drug Program and other NYS Medicaid Pharmacy PA programs, including upcoming changes to the PA process, please continue to visit the following sites: https://newyork.fhsc.com/ and www.nyhealth.gov.