New York
Provider Communications

Jun 1, 2019 • Products & Programs / Pharmacy

As a reminder, beginning on January 2019, providers are able to visit the Pharmacy Information page to review clinical criteria for all injectable, infused or implanted prescription drugs. 

What is changing?

• Beginning on June 15, 2019, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Empire's medical specialty drug review team:

• by phone at 1-833-293-0659 or      
• by fax at 1-888-223-0550 or
• Online access at www.Availity.com available 24/7.

• All inquiries about an existing request (initially submitted to AIM or Empire), peer-to-peer review, or reconsideration will be managed by Empire’s medical specialty drug review team.

What is not changing?

• AIM will continue to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Medical policies and clinical guidelines for non-drug specialty topics will continue to reside at the Office of Medical Policy & Technology Assessment (OMPTA) homepage.
• Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams will not change.

For your convenience here is a summary of the medical specialty drug changes:

Prior to June 15, 2019

Beginning June 15, 2019