New York State Medicaid Program

1
New York State Medicaid Program

• Preferred Drug Program (PDP)
• and
• Clinical Drug Review Program (CDRP)
• Kristin Richter, RPh (1/10/07)

2
Preferred Drug Program (PDP)

• Clinically driven
• Evidence based
• Considers safety and efficacy
• Maintains access to all drugs
• Challenges pharmaceutical industry to provide
  competitive prices
• Concept used by private sector, 30 other state
  Medicaid programs, and Medicare
• Savings helps offset future high cost drugs

3
Critical Aspects of PDP Development

• Patient care remains the top priority
• Objective, high quality clinical reviews on
  relative effectiveness of drugs
• Education of prescribers and providers in advance
  of implementation
• Easy to use prior authorization process
• Broad criteria for approval of PA
• Exclusion of certain drug categories

4
PDP Rollout Schedule

• June 28, 2006
• Angiotensin II Receptor Blocking Agents (ARBs)
• ARBs/Diuretics combinations
• Angiotensin Converting Enzyme (ACE) Inhibitors
• ACE/ Diuretic combinations
• Beta Blockers
• Dihydropyridine Calcium Channel Blockers (CCBs)
• CCB/ACE Inhibitor combinations
• Bisphosphonates- Oral

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October 18, 2006

• Anti-Emetics
• Beta Blocker/ Diuretic combinations
• Calcitonins
• Hepatitis C Agents
• HMG-CoA Reductase Inhibitors (Statins)
• Intranasal Steroids
• Leukotriene Modifiers
• Long Acting Narcotics

• Proton Pump Inhibitors
• Serotonin Receptor Agonists (Triptans)
• Second Generation Antihistamines
• Sedative Hypnotic/ Sleep Agents
• Thiazolidinediones (TZDs)
• Triglyceride Lowering Agents

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February 1, 2007

• Anti-Fungals
• Anti-Virals
• Cephalosporins-Third Generation
• Fluoroquinolones (oral)
• Immunomodulators (topical)
• Inhaled Anticholinergics
• Inhaled beta2 Adrenergic Agents-long and short
  acting
• Inhaled Corticosteroids
• Phosphate Binders/Regulators

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Important Changes for Prescribers to Remember!!

• PPIs and Second Generation Antihistamines are now
  subject to the Preferred Drug Program.
• Nexium, Prilosec OTC and Prevacid capsules are
  preferred agents and do not require a Prior
  Authorization!
• When prescribing a non-preferred PPI or Second
  Generation Antihistamine, prior authorization is
  obtained through the staffed clinical call
  center.

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PDP Facts

• The prescriber, or their authorized agent, can
  complete the PDP prior authorization process.
• Requests for prior authorization of PDP drugs can
  be faxed.
• Some drugs have clinical criteria for prior
  authorization.

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The Clinical Drug Review Program (CDRP)

• A prior authorization program aimed at assuring
  specific drugs are utilized in a medically
  appropriate manner.
• Drugs currently subject to this program include
• Revatio
• Serostim
• Zyvox

10
CDRP Facts

• Only the prescriber, not their authorized agent,
  can complete the CDRP prior authorization
  process.
• Requests for prior authorization of CDRP drugs
  cannot be faxed.
• Written documentation may be required for review
  by clinical call center staff.
• There are clinical criteria that must be met.
• Clinical criteria is available at
  http//newyork.fhsc.com/providers/CDRP_forms.asp

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Easy to Use Prior Authorization Process

• Call 1-877-309-9493 and follow the appropriate
  prompts.
• All PDP and CDRP prior authorizations are
  processed by the staffed Clinical Call Center
  which operates 24 hours per day, 7 days per week.
• Fax line 1-800-268-2990 (fax requests for PDP
  drugs may take up to 24 hours to process).

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PA Process for Prescribers

• Call 1-877-309-9493
• Press 1 for prescriber
• Press 2 if calling to request PA for a
  mandatory generic program drug
• Press 1 if calling to request PA for all other
  drugs
• Press 3 if unsure of which choice to make or if
  you require technical assistance and your call
  will be directed to a clinical call center
  representative

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PA Validation for Pharmacy Providers

• Call 1-877-309-9493
• Press 2 for pharmacy.
• Press 1 to validate a Prior Authorization
  number that ends with the letter W.
• Press 2 to validate a Prior Authorization
  number that does not end with the letter W.
• Press 3 if you require technical assistance.
• Once you have provided all required information,
  you will receive confirmation that you have
  authorization to dispense the drug.
• Reminder to facilitate the prior authorization
  process, please make sure you have the drug in
  stock and can provide a valid 11- digit NDC
  number.

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Pharmacy Prior Authorization Program Reminders

• PDP and CDRP pharmacy prior authorization
  validations are processed thru the Interactive
  Voice Response (IVR) system.
• Technical support for all Pharmacy PAs, including
  Mandatory Generic, is handled by the Clinical
  Call Center.
• Mandatory Generic Program prior authorizations
  are processed through the Voice Integrated System
  (VIPS).

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What about newly approved prescription drugs?

• Prescription drugs newly approved by the FDA, in
  classes already on the Preferred Drug List (PDL),
  will be added to the PDL as non-preferred until
  they are reviewed by the PT Committee. This
  process was recommended by the PT Committee in
  June 2006 and subsequently approved by the
  Commissioner of Health.
• Providers should be aware that the addition of
  newly approved drugs to the PDL may occur without
  notification.

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Whats Next?

• Drugs will be added to the PDP and CDRP on an
  ongoing basis.
• Providers will continue to be notified directly
  to announce the addition of new drug classes to
  the PDL or any drugs to the CDRP.
• The PT Committee will begin their annual review
  of the PDL.

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Information on the web

• To view the full PDL and for information on the
  CDRP, visit
• https//newyork.fhsc.com/
• or
• www.nyhealth.gov

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Important Phone Numbers

• Clinical Call Center 1-877-309-9493
• Billing Issues 1-800-343-9000
• Pharmacy Policy 1-518-486-3209
• Recipient Helpline 1-800-541-2831

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Important Resources

• New York State Medicaid
• http//www.nyhealth.gov
• First Health Services Corporation
  http//newyork.fhsc.com
• eMedNY
• http//www.emedny.org/
• Updates, fax forms, provider letters and
  additional information may be accessed at the
  above websites and will also be available in the
  New York Medicaid Update.

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New York State MedicaidPDP and CDRP

• Questions and Discussion