any medication subject to prior authorization or step therapy — Highmark
for a medically fragile child as defined in NY S2121C
Initial criteria
- age < 21 years
- prescriber attests that the medication is medically necessary for a medically fragile child as defined in NY S2121C
Reauthorization criteria
- member continues to meet criteria for being a medically fragile child as defined in NY S2121C
- member is less than 21 years of age
Approval duration
until member turns 21 years of age