NY MedicaidHigh ImpactPrior Auth
Prohibited Prior Authorization Requests
Published May 10, 2026
AI Summary
New York State Medicaid now prohibits third-party entities from submitting prior authorization requests on behalf of prescribers. Only prescribers or their authorized agents (employees with access to patient medical records) may submit PA requests, and outsourcing this function is banned.
Action Required
Immediately: Stop using any third-party services that submit prior authorization requests on behalf of prescribers. Ensure only prescribers or their authorized agents (nurses, medical assistants employed by the practice with patient record access) submit PA requests. Pharmacies must notify prescribers when PA is required but cannot obtain PA on their behalf. Violations risk termination from NY Medicaid program.
Plan Types
Medicaid
States
NY
Specialties
all-specialties