Updated New York State Regulations for Medicaid Opioid Dependence Agents and Opioid Antagonists - Effective March 22, 2022 - Key Updates

Sep 17, 2026

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Updated New York State regulations establish a statewide Medication Assisted Treatment (MAT) formulary for Medicaid Managed Care (MMC) Plans and Medicaid Fee for Service (FFS). The changes align coverage across the Medicaid program under New York Social Services Law § 367-a (7)(e). Effective March 22, 2022, prior authorization requirements are adjusted for substance use disorder medications, brand multi-source drugs are generally filled with generics unless DAW/brand-medically-necessary is indicated, and existing quantity limits remain in place.

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Overview of the statewide MAT formulary

Legal background and effective coverage alignment

Effective March 22, 2022 updates

Prior authorization changes for substance use disorder medications

Generic substitution for brand multi-source drugs

Quantity limits and prior authorization for higher dosing

How to submit prior authorization requests

Updated New York State Regulations for Medicaid Opioid Dependence Agents and Opioid Antagonists On October 1, 2021, New York State (NYS) implemented a single Medication Assisted Treatment (MAT) formulary in accordance with § 367-a (7) (e) of Social Services Law, which enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MMC) Plans and the Medicaid Fee for Service (FFS) Program. Under this statewide formulary, MMC and FFS Members will follow a single formulary and coverage parameters consistent across the Medicaid Program. On December 22, 2021, New York Governor Kathy Hochul signed Chapter 720 into law. This law amends NYS Social Services Law and Public Health Law, in relation to medication for the treatment of substance use disorders. Effective March 22, 2022, the following changes will be made to comply with the new law: • Prior authorization (PA) will no longer be required for medications used for the treatment of substance use disorders when prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder. Medication examples include brand Suboxone films, generic Suboxone (buprenorphine-naloxone) films, buprenorphine sublingual tablets, buprenorphine-naloxone sublingual tablets, naloxone nasal spray (generic Narcan) and Brand Narcan nasal spray. Visit [newyork.fhsc.com/providers/mat.asp](newyork.fhsc.com/providers/mat.asp to)[ to](newyork.fhsc.com/providers/mat.asp to) review the Single Statewide Medication Assisted Treatment (MAT) Formulary. • Prescriptions for a brand name multi-source drug (a brand name drug that has a generic equivalent, such as brand Suboxone films) will be filled with a generic equivalent, as required by NYS Social Services and Education Law, unless the prescriber indicates “Dispense as Written (DAW) and “Brand Medically Necessary” on the prescription. • The current quantity limits for all of these products will remain the same. If a Member’s therapy requires them to be on the medication dosed greater than the quantity limit, you may submit a Prior Authorization request, including clinical documentation to support its use in any of the following ways: 1. Sign in to your MVP Provider Online Account at [mvphealthcare.com](mvphealthcare.com) and use the new electronic PA tool powered by Novologix. 2. Use the appropriate MVP Prior Authorization form, which can be accessed at [mvphealthcare.com/Providers](mvphealthcare.com/Providers), then select Forms, then Prior Authorization, then select the appropriate form within the Pharmacy section. Completed forms should be faxed to MVP at 1-800-376-6373. 3. Submit a request through Surescripts or CoverMyMeds.

FAQs

What is the statewide MAT formulary introduced for New York Medicaid?

New York implemented a single Medication Assisted Treatment formulary for both Medicaid Managed Care (MMC) and Medicaid Fee for Service (FFS), creating consistent coverage parameters statewide for opioid antagonists and opioid dependence agents.

When does prior authorization stop being required under the updated rules?

Prior authorization is no longer required for medications used to treat substance use disorders when prescribed according to generally accepted national professional guidelines.

How are brand multi-source drug prescriptions handled?

Brand multi-source drugs are generally filled with their generic equivalent unless the prescriber indicates “Dispense as Written (DAW)” and “Brand Medically Necessary” on the prescription.

What happens if a member needs medication dosed above the quantity limits?

Quantity limits remain the same, but providers may submit a prior authorization request with clinical documentation to support use at doses greater than the limit.

Sep 17, 2026

Upload by Mabel