← All states
NY

New York Prior Authorization Requirements

Medicare TraditionalMedicaid MCOMedicare AdvantagePart DMedicaid FFSDual-EligibleCommercial (employer / fully-insured)NY Medicaid RxCommercial — Marketplace QHP

PA required

61%

1,150 verified rules

Verified Jun 8, 2026

Service category PA

All programs combined
Specialty Drugs
9/10Conditional
Durable Medical Equipment
9/10Conditional
Skilled Nursing Facility
8/10Conditional
Outpatient Surgery
8/10Conditional
Inpatient Hospital
8/10Conditional
Mental Health — Inpatient
8/10Conditional
Home Health
8/10Conditional
Ambulance Transport
7/10Conditional
Occupational Therapy
7/10Conditional
Physical Therapy
7/10Conditional
Speech Therapy
7/10Conditional
Substance Use Treatment
7/10Conditional
advanced_imaging
7/10Conditional
Diagnostic Imaging
7/10Conditional
Laboratory
0/10No PA

Drug class PA

Part D federal protections flagged
Oral Oncology
15/17Conditional
ADHD Stimulants
14/16Conditional
pulmonary_arterial_hypertension
11/11Full PA
hepatitis_c_daa
11/11Full PA
growth_hormone
11/11Full PA
migraine_cgrp
11/11Full PA
antifungals_systemic
10/11Conditional
asthma_copd_biologics
10/10Full PA
testosterone_androgens
10/11Conditional
atypical_antipsychotics
10/11Conditional
tnf_inhibitors
10/10Full PA
il_inhibitors_biologics
10/10Full PA
jak_inhibitors
10/10Full PA
ms_disease_modifying
10/10Full PA
hereditary_angioedema
10/10Full PA
pcsk9_inhibitors
9/10Conditional
glp1_agonists
9/9Full PA
Immunosuppressants
8/10Conditional
inhaled_respiratory
8/11Conditional
anticonvulsants
8/10Conditional
opioid_analgesics
8/10Conditional
nsaids
7/10Conditional
antiplatelets
7/11Conditional
oral_retinoids
7/10Conditional
Rare Disease / Orphan
7/8Conditional
other_antidepressants
7/9Conditional
Specialty Non-Biologic
6/7Conditional
Controlled — Schedule II
6/7Conditional
anxiolytics_benzodiazepines
6/11Conditional
Biosimilars
6/7Conditional
skeletal_muscle_relaxants
6/10Conditional
Diabetes — Insulin
6/7Conditional
Brand (Generic Available)
6/7Conditional
Antipsychotics
6/8Conditional
Specialty Biologics
6/7Conditional
Diabetes — Non-Insulin
6/7Conditional
Controlled — Schedule III–V
6/7Conditional
Brand (No Generic)
6/7Conditional
Hepatitis C
6/7Conditional
hemophilia_factors
5/5Full PA
Antidepressants
5/7Conditional
ppi_acid_reducers
5/10Conditional
sedative_hypnotics
4/10Conditional
overactive_bladder
4/11Conditional
other_antidiabetics
4/10Conditional
vmat2_inhibitors
4/4Full PA
insulins
4/11Conditional
HIV Antiretrovirals
4/17Conditional
opioid_use_disorder
4/11Conditional
wakefulness_agents
4/4Full PA
cystic_fibrosis_modulators
4/4Full PA
arbs
3/10Conditional
weight_loss_agents
3/4Conditional
calcium_channel_blockers
3/10Conditional
oncology_supportive
3/3Full PA
statins
3/11Conditional
oxybate_salts
3/3Full PA
dermatology_biologics
3/3Full PA
enzyme_replacement
3/3Full PA
dalfampridine
3/3Full PA
immunoglobulins
3/3Full PA
triptans
2/11Conditional
topical_steroids
2/5Conditional
hepatitis_b_agents
2/2Full PA
GLP-1 (Weight Loss)
2/7Conditional
sglt2_inhibitors
2/9Conditional
dpp4_inhibitors
2/9Conditional
ssri_antidepressants
2/9Conditional
anticoagulants_doac
2/10Conditional
infertility_agents
2/2Full PA
erectile_dysfunction
2/2Full PA
hematopoietic_growth_factors
2/2Full PA
antihistamines
2/8Conditional
antiparkinson_agents
2/2Full PA
antibiotics_inhaled
1/1Full PA
Compounded Medications
1/7Conditional
antivirals_covid
1/1Full PA
antivirals_oral
1/1Full PA
cephalosporins_third_gen
1/1Full PA
fluoroquinolones_oral
1/1Full PA
hepatitis_b_antivirals
1/2Conditional
tetracyclines
1/2Conditional
ace_inhibitors
1/10Conditional
beta_blockers
1/10Conditional
hiv_prep
1/1Full PA
alzheimers_therapy
1/1Full PA
otc_covid_antigen_test
1/1Full PA
methadone
1/2Conditional
esketamine
1/2Conditional
non24_sleep_wake
1/1Full PA
ace_inhibitor_combinations
1/1Full PA
arb_combinations
1/1Full PA
sulfasalazine_derivatives
1/1Full PA
urea_cycle_disorders
1/1Full PA
beta_blockers_diuretics
1/1Full PA
anticoagulants_injectable
1/1Full PA
cholesterol_absorption_inhibitors
1/1Full PA
immunosuppressives_oral
1/1Full PA
copd_agents
1/1Full PA
triglyceride_lowering_agents
1/1Full PA
progestins_cachexia
1/1Full PA
non_ergot_dopamine_agonists
1/1Full PA
epinephrine_self_administered
1/1Full PA
glp1_diabetes
1/1Full PA
acne_topical
1/1Full PA
actinic_keratosis_agents
1/1Full PA
antibiotics_ophthalmic
1/1Full PA
antibiotics_topical
1/1Full PA
antihistamines_ophthalmic
1/1Full PA
corticosteroids_intranasal
1/1Full PA
antifungals_topical
1/1Full PA
anti_infectives_topical
1/1Full PA
fluoroquinolones_ophthalmic
1/1Full PA
antivirals_topical
1/1Full PA
prostaglandin_agonists_ophthalmic
1/1Full PA
anabolic_steroids_injectable
1/1Full PA
psoriasis_topical
1/1Full PA
dry_eye_agents
1/1Full PA
rosacea_topical
1/1Full PA
bisphosphonates_oral
1/1Full PA
glucagon_agents
1/1Full PA
alpha_reductase_inhibitors_bph
1/1Full PA
glucocorticoids_oral
1/1Full PA
pancreatic_enzymes
1/1Full PA
antiemetics
1/2Conditional
gastrointestinal_antibiotics
1/1Full PA
h_pylori_agents
1/1Full PA
beta_blockers_ophthalmic
1/1Full PA
nsaids_ophthalmic
1/1Full PA
fluoroquinolones_otic
1/1Full PA
antihyperuricemics
1/1Full PA
cystine_depleting_agents
1/1Full PA
electrolyte_depleters
1/1Full PA
lidocaine_patches
1/1Full PA
phosphate_binders
1/2Conditional
selective_alpha_adrenergic_blockers
1/1Full PA
oxazolidinone_antibiotics
1/1Full PA
uterine_disorder_treatments
1/1Full PA
antihistamines_intranasal
1/1Full PA
antihistamines_second_generation
1/1Full PA
beta2_agonists_inhaled_short_acting
1/1Full PA
corticosteroids_inhaled
1/1Full PA
leukotriene_modifiers
1/10Conditional
corticotropin
1/1Full PA
anabolic_steroids_oral
1/1Full PA
anti_diarrheal_agents
1/1Full PA
constipation_agents
1/1Full PA
hormone_replacement_therapy
1/1Full PA
diabetic_test_strips
1/1Full PA
setmelanotide
1/1Full PA
ovulation_enhancing_drugs
1/1Full PA
pubertal_suppressants
1/1Full PA
parathyroid_hormone_analogs
1/1Full PA
pyrimethamine
1/1Full PA
topical_compounded_prescriptions
1/1Full PA
snri_antidepressants
1/3Conditional
antibacterials_systemic
1/1Full PA
antiparasitics
1/1Full PA
antivirals_other
1/2Conditional
ophthalmic_dry_eye_misc
1/1Full PA
roflumilast
1/3Conditional
sexual_dysfunction_agents
1/1Full PA
bisphosphonates
1/10Conditional
electrolytes_vitamins
1/1Full PA
osteoporosis_anabolics
1/1Full PA
pulmonary_fibrosis
1/1Full PA
respiratory_allergy_cough_cold
1/1Full PA
metabolic_bone_other
1/1Full PA
gi_bowel_motility
1/1Full PA
ophthalmic_anti_inflammatory_anti_infective
1/1Full PA
cns_miscellaneous
1/1Full PA
immunological_immunomodulators
1/1Full PA
thyroid_agents
1/3Conditional
sleep_and_wakefulness_agents
1/1Full PA
estrogens_hrt
1/1Full PA
other_lipid_agents
1/1Full PA
gnrh_oncology_hormonal
1/1Full PA
miscellaneous_specialty
1/1Full PA
ophthalmic_agents
1/1Full PA
other_cardiovascular
1/1Full PA
antibiotics_general
1/1Full PA
diuretics
1/3Conditional
continuous_glucose_monitors
1/1Full PA
gi_other
1/1Full PA
allergen_immunotherapy
1/1Full PA
cough_cold
1/1Full PA
transplant_immunosuppressants
1/1Full PA
cannabidiol
1/2Conditional
il1_other_immunomodulators
1/1Full PA
parkinsons_agents
1/1Full PA
viscosupplements
1/1Full PA
als_agents
1/1Full PA
narcolepsy_cataplexy_agents
1/1Full PA
botulinum_toxins
1/1Full PA
oncology_hormonal
1/2Conditional
fertility_regulators
1/1Full PA
acromegaly_agents
1/1Full PA
growth_improvement_agents
1/1Full PA
calcium_receptor_agonists
1/1Full PA
polyneuropathy_agents
1/1Full PA
movement_disorders
1/1Full PA
carnitine_deficiency_agents
1/1Full PA
immunologic_misc
1/1Full PA
dermatology_antipsoriatics
1/1Full PA
calcium_regulators_misc
1/1Full PA
alpha1_antitrypsin_deficiency
1/1Full PA
multiple_sclerosis_agents
1/1Full PA
central_precocious_puberty
1/1Full PA
urea_cycle_disorder
1/1Full PA
myasthenia_gravis_agents
1/1Full PA
vasopressins
1/1Full PA
endometriosis_agents
1/1Full PA
hereditary_tyrosinemia
1/1Full PA
platelet_disorders
1/1Full PA
ophthalmic_anti_vegf
1/2Conditional
immunomodulators
1/1Full PA
chelating_agents
1/1Full PA
uterine_fibroids
1/1Full PA
cortisol_synthesis_inhibitors
1/1Full PA
bleeding_disorders_agents
1/1Full PA
sickle_cell_disease
1/1Full PA
autoimmune_physician_administered
1/1Full PA
paroxysmal_nocturnal_hemoglobinuria
1/1Full PA
pulmonary_fibrosis_agents
1/1Full PA
pde4_inhibitors_inflammatory
1/1Full PA
antibiotics_misc
1/1Full PA
cough_cold_allergy
1/1Full PA
metabolic_disorder_agents
1/1Full PA
dermatology_topical_other
1/1Full PA
il_inhibitors_ibd
1/1Full PA
hematopoietic_esa
1/1Full PA
ophthalmic_anti_inflammatory
1/1Full PA
calcimimetics
1/1Full PA
ovulation_stimulants
1/1Full PA
immunosuppressants_misc
1/1Full PA
neuro_psych_misc
1/1Full PA
cardiovascular_agents
1/1Full PA
hormone_replacement_contraceptives
1/1Full PA
ssri_snri_other_antidepressants
1/1Full PA
Opioid Treatment (MOUD)
0/7No PA
cns_misc
0/1No PA
cannabinoid_antiemetics
0/2No PA
bph_agents
0/2No PA
bipolar_agents_lithium
0/1No PA
otic_agents
0/4No PA
antidementia_alzheimers
0/1No PA
oral_corticosteroids
0/1No PA
anaphylaxis_epinephrine
0/1No PA
dental_oral_agents
0/1No PA
antimyasthenic_agents
0/1No PA
antimycobacterials_tb
0/1No PA
antigout_agents
0/1No PA
inflammatory_bowel_disease
0/2No PA
vaccines
0/2No PA
contraceptives
0/3No PA
feminine_products
0/1No PA
alzheimers_agents
0/2No PA
dental_products
0/1No PA
nutritional_dietary
0/1No PA
vitamins
0/2No PA
smoking_cessation
0/1No PA
anti_infectives_misc
0/1No PA
digitalis_glycosides
0/1No PA
direct_renin_inhibitors
0/1No PA
gout_agents
0/1No PA
non_opioid_analgesics
0/2No PA
cardiovascular_misc
0/1No PA
salicylates
0/1No PA
aldosterone_antagonists
0/1No PA
alcohol_deterrents
0/1No PA
musculoskeletal_therapy_agents
0/1No PA
anthelmintics
0/2No PA
alpha_blockers
0/1No PA
antibacterials_misc
0/1No PA
antiarrhythmics
0/2No PA
antimalarials
0/2No PA
antilipemics_bile_acid_resins
0/1No PA
macrolides
0/1No PA
fluoroquinolones
0/1No PA
antilipemics_cholesterol_absorption
0/1No PA
antiparkinsonian_agents
0/1No PA
psychotherapeutic_misc
0/1No PA
antitubercular_agents
0/1No PA
antilipemics_fibrates
0/1No PA
smoking_deterrents
0/1No PA
glucocorticoids
0/1No PA
gi_antispasmodics
0/1No PA
antivirals_systemic
0/1No PA
glucose_elevating_agents
0/1No PA
cephalosporins
0/1No PA
antilipemics_misc
0/1No PA
antidementia_agents
0/1No PA
diabetic_supplies
0/1No PA
rectal_corticosteroids
0/1No PA
ophthalmic_sympathomimetics
0/1No PA
dermatology_antiseborrheics
0/1No PA
nitrates
0/1No PA
anaphylaxis_treatment_agents
0/1No PA
dermatology_local_anesthetics
0/1No PA
fibromyalgia_agents
0/1No PA
allergenic_extracts
0/1No PA
dermatology_actinic_keratosis
0/1No PA
migraine_ergotamines
0/1No PA
menopausal_symptom_agents
0/1No PA
gastrointestinal_misc
0/1No PA
ophthalmic_prostaglandins
0/1No PA
dermatology_antifungals
0/1No PA
ophthalmic_rho_kinase_inhibitors
0/1No PA
mood_stabilizers
0/1No PA
progestins
0/1No PA
benign_prostatic_hyperplasia
0/1No PA
genitourinary_misc
0/1No PA
electrolytes
0/1No PA
dermatology_misc
0/1No PA
vaginal_anti_infectives
0/2No PA
prenatal_vitamins
0/1No PA
cold_cough
0/1No PA
dermatology_scabicides_pediculicides
0/1No PA
postherpetic_neuralgia
0/1No PA
antidiarrheals
0/1No PA
ophthalmic_antiglaucoma_beta_blockers
0/1No PA
mast_cell_stabilizers
0/1No PA
ophthalmic_carbonic_anhydrase_inhibitors
0/1No PA
dermatology_acne
0/1No PA
endocrine_metabolic_misc
0/1No PA
dmards
0/1No PA
dermatology_antipruritic
0/1No PA
potassium_removing_agents
0/1No PA
ulcer_therapy_combinations
0/1No PA
ophthalmic_other
0/1No PA
nutritional_misc
0/1No PA
dermatology_rosacea
0/1No PA
vitamin_d_analogs
0/1No PA
dermatology_wound_care
0/1No PA
gi_anticholinergics
0/1No PA
ophthalmic_antiallergics
0/1No PA
mouth_throat_dental_agents
0/1No PA
ophthalmic_antiglaucoma_combinations
0/1No PA
respiratory_misc
0/1No PA
h2_receptor_antagonists
0/1No PA
ophthalmic_anti_infectives
0/1No PA
ophthalmic_anti_inflammatories
0/1No PA
xanthines
0/1No PA
laxatives
0/2No PA
ophthalmic_misc
0/1No PA
dermatology_antibiotics
0/1No PA
ophthalmic_anti_infective_anti_inflammatory
0/1No PA
antianginal_nitrates
0/1No PA
antimyasthenic_cholinergic
0/1No PA
digestive_enzymes
0/1No PA
serms
0/1No PA
interstitial_cystitis
0/1No PA
corticosteroids_systemic
0/1No PA
antipsoriatics_topical
0/1No PA
estrogens_progestins
0/1No PA
hemostatics
0/1No PA
anticoagulants_warfarin
0/1No PA
opioid_reversal_antidotes
0/1No PA
other_antihyperlipidemics
0/1No PA
antimycobacterial
0/1No PA
cardiotonics
0/1No PA
vasopressin_desmopressin
0/1No PA
anticoagulants_heparins
0/1No PA
ophthalmic_glaucoma
0/1No PA
antidiarrheal_probiotic
0/1No PA
arni_sacubitril
0/1No PA
smoking_alcohol_deterrents
0/1No PA
vitamins_minerals
0/1No PA
other_antihypertensives
0/1No PA
hematinics_other
0/1No PA
fibromyalgia_snri
0/1No PA
nutritional_metabolic
0/1No PA
topical_anti_infectives
0/1No PA
vaccines_toxoids
0/1No PA
mouth_throat_dental
0/1No PA
medical_supplies_devices
0/1No PA
vasopressors_anaphylaxis
0/1No PA
anorectal_rectal
0/1No PA
pharmaceutical_adjuvants
0/1No PA

PA type breakdown

clinical_criteria
500
Conditional
122
Full PA
82

Federal protected classes requiring PA

AntipsychoticsPA required
AntidepressantsPA required
AntidepressantsPA required
AntipsychoticsPA required
Oral OncologyPA required
ImmunosuppressantsPA required
ImmunosuppressantsPA required
Oral OncologyPA required

State flags

Medicaid expansion state
WISeR pilot (high data quality)
FFS-dominant (minimal MCO)

Look up a specific PA rule for New York

Type a drug brand or service. Pick a program. Get the verdict, source URL, and confidence score in under 300ms.

Look up a NY rule →← All states
New York Prior Authorization Requirements | Auth57 Labs