Cuomo Approves Standardized PA Drug Authorization Form Process

Governor Cuomo Signs Standardized Prior Prescription Drug Authorization Form Legislation


Thanks in part to the many calls made by NYAPRS members and colleagues, Governor Cuomo signed A.10248-B into law this past Wednesday night.

This law will make it easier for prescribers to get Medicaid beneficiaries the particular medication they need and want, regardless if it’s not on the list of approved medications (formularies) of the 18 health plans that took over managing the pharmacy benefit this past January.

Each plan had been using its own "prior authorization" procedure and form for prescribers to use, which was making it even harder for beneficiaries to get their desired and need medication.

We want to thank Governor Cuomo, bill sponsors former Assemblyman (and how Department of Labor Commissioner) Peter Rivera and Senator Kemp Hannon and all of you who joined in the advocacy for getting this into law.

Prior authorization (PA) is a process which allows the plans some latitude in either approving or denying a PA request. Thankfully, New York’s Medicaid program will go one step further as regards anti-psychotic medications by implanting a 'prescriber prevails' program which requires plans to make off-formulary anti-psychotic meds available if a prescriber asks for that. This was achieved in legislation approved this past year, again partly due to your advocacy efforts.

NYAPRS, MHANYS and some other advocates are serving on a DOH/OMH work group looking into medication access. Stay tuned for more details!



From: [] On Behalf Of Harvey Rosenthal
Sent: Friday, September 28, 2012 8:51 AM
Subject: [NYAPRS Enews] Urge Gov Cuomo to Sign Bills Improving Vet Servicesand Medication Access




Two bills of great importance to New York’s behavioral health community were sent over to Governor Cuomo’s office this past week for his approval and signature that require your support!

  • One would require the Veteran’s Commission to work with the Departments of Health and Labor and the Office of Mental Health and Alcoholism and Substance Abuse Services to create and report annually on a plan to boost coordinated suicide prevention, peer support and employment services for veterans in need.
  • The other would require the 21 managed care (health) plans that took over the pharmacy benefit last January to all use on standard form to allow doctors to apply for their patients to have a medication that is not on the plan’s approved list (formulary).


Please support them by calling Governor Cuomo this week at (518) 474-8390

and leave the following message:

“I’m a registered voter from (your locality) calling to

urge Governor Cuomo to sign Assembly bills 9415 and A.10248-B.


Here are more details about each bill:


"Veterans Mental Health and Chemical Dependency Act", which

  • directs the veterans affairs commission to develop and update a New York state interagency plan to improve outreach, assessment and care for veterans and their families who are experiencing mental health, major depression and/or substance abuse problems and
  • requires a report be issued each year after the effective date.


Key Bill Excerpt by NYAPRS

“The commission shall develop and update, in consultation  with  the office  of  mental  health, the office of alcoholism and substance abuse services, department of health and department of labor, a New York State interagency plan to improve outreach, assessment, and care for  veterans and  their families who are experiencing mental health, major depression and/or  substance  abuse problems. The plan would address the need for a range of additional services, including, but not limited to:

a. The need for housing that is accessible to veterans  with  physical and/or mental disabilities;

b. Suicide prevention;

c.  Services  that address the special needs of female service members or veterans;

d. Services that address the  special  needs  of  physically  disabled veterans;

e. Peer outreach and support programs;

f.  Services  to  meet the emotional needs of children, spouse, and/or domestic partner of service members or veterans;

g. Services and consultation for veterans in search of employment; and

h. Accessibility and coordination of information.”


A.1024B (Rivera) which directs the Commissioner Of Health to develop a standard prior prescription drug authorization request form for managed care providers.


Key Bill Excerpt by NYAPRS

The Commissioner of Health shall develop a standard prior authorization request form or forms to be utilized by all managed care providers for purposes of submitting a request for a utilization review determination for coverage of prescription drug benefits under this title. The managed care provider shall make the standard prior authorization request form or forms available to, and shall accept it or them from, prescribing providers in paper and electronic form.