N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-10.13
Current through Register Vol. 46, No. 45, November 2, 2024
A request for prior approval of treatment with a specialty drug must be accompanied by a written statement from the enrollee's treating physician stating why treatment with the specialty drug is necessary, what other alternatives have been tried or explored, and what testing the enrollee has undergone for purposes of determining whether treatment with the specialty drug is appropriate and safe for the enrollee. All requests for prior approval for treatment with a specialty drug will be reviewed by the pharmacy benefits manager for the fund administrator and a determination will be made within three business days of receipt of all necessary information from the enrollee's treating physician.
N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-10.13