NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
ANALGESICS Cyclooxygenase II (COX II) Inhibitors Cyclooxygenase II (COX II) Inhibitors Non-Steroidal Anti-Inflammatory Drugs Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – Prescription (NSAIDS) – Prescription TTP://NE Opioids – Long-Acting Opioids – Long-Acting
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Opioids – Short-Acting Opioids – Short-Acting
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
FERRE II. ANTI-INFECTIVES Anti-Fungals – Oral for Onychomycosis Anti-Fungals – Oral for Onychomycosis Anti-Virals - Oral Anti-Virals - Oral
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Cephalosporins – Third Generation Cephalosporins – Third Generation Fluoroquinolones – Oral Fluoroquinolones – Oral Hepatitis B Agents Hepatitis B Agents Hepatitis C Agents - Injectabl Hepatitis C Agents - Injectabl Hepatitis C Agents - Oral Hepatitis C Agents - Oral
Victrelis™ Tetracyclines Tetracyclines
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
III. CARDIOVASCULAR Angiotensin Converting Enzyme Inhibitors Angiotensin Converting Enzyme Inhibitors ACEIs + Calcium Channel Blockers ACEIs + Calcium Channel Blockers ACEIs + Diuretics ACEIs + Diuretics TTP://NE Angiotensin Receptor Blockers (ARBs) Angiotensin Receptor Blockers (ARBs) ARBs + Calcium Channel Blockers ARBs + Calcium Channel Blockers ARBs + Diuretics ARBs + Diuretics
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Beta Blockers Beta Blockers Beta Blockers + Diuretics Beta Blockers + Diuretics TTP://NE Bile Acid Sequestrants Bile Acid Sequestrants Calcium Channel Blockers Calcium Channel Blockers (Dihydropyridine) (Dihydropyridine) Cholesterol Absorption Inhibitors Cholesterol Absorption Inhibitors Direct Renin Inhibitors Direct Renin Inhibitors
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Endothelin Receptor Antagonists for Endothelin Receptor Antagonists for Pulmonary Arterial Hypertension (PAH) Pulmonary Arterial Hypertension (PAH) HMG-CoA Reductase Inhibitors (Statins) HMG-CoA Reductase Inhibitors (Statins) Niacin Derivatives Niacin Derivatives Phosphodiesterase type-5 (PDE-5) Phosphodiesterase type-5 (PDE-5) Inhibitors for PA Inhibitors for PA TTP://NE Triglyceride Lowering Agents Triglyceride Lowering Agents IV. CENTRAL NERVOUS SYSTEM Alzheimer’s Agents Alzheimer’s Agents
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Anticonvulsants – Second Generation Anticonvulsants – Second Generation Atypical Antipsychotics Atypical Antipsychotics
NON-PREFERRED AGENTS (PA REQUIREMENTS EFFECTIVE
Benzodiazepines - Rectal Benzodiazepines - Rectal Carbamazepine Derivatives Carbamazepine Derivatives
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Central Nervous System (CNS) Central Nervous System (CNS) Stimulan Stimulan Multiple Sclerosis Agents Multiple Sclerosis Agents Non-Ergot Dopamine Receptor Agonists Non-Ergot Dopamine Receptor Agonists Other Agents for Attention Deficit Other Agents for Attention Deficit Hyperactivity Disorder (ADHD) Hyperactivity Disorder (ADHD) Sedative Hypnotics/Sleep Agents Sedative Hypnotics/Sleep Agents
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Selective Serotonin Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors Serotonin-Norepinephrine Reuptake Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Inhibitors (SNRIs) Serotonin Receptor Agonists (Triptans Serotonin Receptor Agonists (Triptan P V. DERMATOLOGIC AGENTS Agents for Actinic Keratosis Agents for Actinic Keratosis Antibiotics – Topical Antibiotics – Topical
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Anti-Fungals - Topical Anti-Fungals – Topica
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
Anti-Virals – Topical Anti-Virals – Topical Immunomodulators – Topica Immunomodulators – Topica Psoriasis Agents – Topical Psoriasis Agents – Topical Steroids, Topical – Low Potency Steroids, Topical – Low Potenc
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Steroids, Topical – Medium Potency Steroids, Topical – Medium Potenc
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
Steroids, Topical – High Potency Steroids, Topical – High Potenc
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
Steroids, Topical – Very High Potency Steroids, Topical – Very High Potenc
NON-PREFERRED AGENTS (PA EFFECTIVE 8/25/2011)
D VI. ENDOCRINE AND METABOLIC AGENTS Amylin Analogs Amylin Analogs Anabolic Steroids – Topica Anabolic Steroids – Topica
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Biguanides Biguanides Bisphosphonates – Ora Bisphosphonates – Ora Calcitonins – Intranasal Calcitonins – Intranasal Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Glucagon-like Peptide-1 (GLP-1) Agonists Glucagon-like Peptide-1 (GLP-1) Agonists Growth Hormone Growth Hormone
PREFERRED AGENTS (SUBJECT TO CDRP FOR AGE 21 YEARS & NON-PREFERRED AGENTS (SUBJECT TO CDRP FOR AGE 21
Insulin – Long-Acting Insulin – Long-Acting Insulin – Mixes Insulin – Mixes Insulin – Rapid-Acting Insulin – Rapid-Acting
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Pancreatic Enzymes Pancreatic Enzymes Thiazolidinediones (TZDs) Thiazolidinediones (TZDs) C VII. GASTROINTESTINAL Anti-Emetics Anti-Emetics Helicobacter pylori Agents Helicobacter pylori Agents TTP://NE Proton Pump Inhibitors (PPIs Proton Pump Inhibitors (PPIs Sulfasalazine Derivatives Sulfasalazine Derivatives VIII. HEMATOLOGICAL AGENTS Anticoagulants – Injectable Anticoagulants – Injectable
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Anticoagulants – Oral Anticoagulants – Oral Erythropoiesis Stimulating Agents (ESAs) Erythropoiesis Stimulating Agents (ESAs) Platelet Inhibitors Platelet Inhibitors IX. IMMUNOLOGIC AGENTS Immunomodulators – Injectable Immunomodulators – Injectable TTP://NE MISCELLANEOUS Progestins (for Cachexia) Progestins (for Cachexia) P XI. MUSCULOSKELETAL AGENTS Skeletal Muscle Relaxants Skeletal Muscle Relaxants
orphenadrine comp. forte carisoprodol compound
N XII. OPHTHALMICS Alpha-2 Adrenergic Agonists (for Alpha-2 Adrenergic Agonists (for Glaucoma) – Ophthalmic Glaucoma) – Ophthalmic
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Antihistamines – Ophthalmic Antihistamines – Ophthalmic Beta Blockers – Ophthalmics Beta Blockers – Ophthalmics Fluoroquinolones – Ophthalm Fluoroquinolones – Ophthalm TTP://NE Non-Steroidal Anti-Inflammatory Drugs Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – Ophthalmic (NSAIDS) – Ophthalmic Prostaglandin Agonists – Ophthalmic Prostaglandin Agonists – Ophthalmic N XIII. OTICS Fluoroquinolones – Otic Fluoroquinolones – Otic
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
XIV. RENAL AND GENITOURINARY Alpha Reductase Inhibitors for BPH Alpha Reductase Inhibitors for BPH Phosphate Binders/Regulators Phosphate Binders/Regulators Selective Alpha Adrenergic Blockers Selective Alpha Adrenergic Blockers Urinary Tract Antispasmodics Urinary Tract Antispasmodics Xanthine Oxidase Inhibitors Xanthine Oxidase Inhibitors D XV. RESPIRATORY Anticholinergics – Inhaled Anticholinergics – Inhaled Antihistamines – Intranasal Antihistamines – Intranasal
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Antihistamines – Second Generation Antihistamines – Second Generation Beta2 Adrenergic Agents – Inhaled Long Beta2 Adrenergic Agents – Inhaled Long Beta2 Adrenergic Agents – Inhaled Short Beta2 Adrenergic Agents – Inhaled Short TTP://NE Corticosteroids – Inhale Corticosteroids – Inhale Corticosteroid/Beta Corticosteroid/Beta 2 Adrenergic Agent 2 Adrenergic Agent (Long-Acting) Combinations – Inhale (Long-Acting) Combinations – Inhale Corticosteroids – Intranasa Corticosteroids – Intranasa
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
NEW YORK STATE MEDICAID PREFERRED DRUG LIST
Non-preferred drugs in these classes require prior authorization (PA), unless indicated otherwise.
Preferred drugs that require prior authorization are indicated by footnote.
Leukotriene Modifiers Leukotriene Modifiers
CDRP All drugs in class are subject to Clinical Drug Review Program PA requirements (See:
DUR Please see Drug Utilization Review (DUR) recommendations for drug class or specific drugs noted. (See:
DEPARTMENT OF HEALTH & HUMAN SERVICES Food and Drug Administration Silver Spring, MD 20993 TRANSMITTED BY FACSIMILE Fadwa Almanakly, Pharm.D. Associate Director, Advertising and Promotions Bayer HealthCare Pharmaceuticals Inc. 6 West Belt Wayne, NJ 07470-6806 RE: NDA 21-225 Mirena® (levonorgestrel-releasing intrauterine system) MACMIS # 18166 The Division of Drug Marketing, A
Kids Health Info FACT SHEET Threadworms Threadworms are any long slender roundworms, commonly found in preschool and school aged children. They often occurin more than one family member. Threadworms look like white threads, about 8mm long. They live in the lower intestine, but come out of the bottom at nightor in the early morning hours to lay their eggs in the area between the buttocks. T