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PA Bulletin, Doc. No. 01-2335


Medical Assistance Program Prior Authorization

[31 Pa.B. 7077]

   The purpose of this notice is to add an item to the Medical Assistance (MA) Program's list of items and services requiring prior authorization.

   Section 443.6(b)(7) of the Public Welfare Code (62 P. S. § 443.6(b)(7)) authorizes the Department of Public Welfare to add items and services to the list of services requiring prior authorization by publication of notice in the Pennsylvania Bulletin.

   Prior authorization for OxyContin®/oxycodone sustained release medication will be required for the following prescriptions dispensed on and after January 7, 2002:

   1)  Prescriptions that exceed dosages of greater than three tablets per day of any single strength of OxyContin®/oxycodone sustained release medication.

   2)  Prescriptions for more than two different strengths of OxyContin®/oxycodone sustained release medications to be taken concurrently.

   Other prescriptions for OxyContin®/oxycodone sustained release medication will not require prior authorization.

   This prior authorization requirement was presented to the MA Advisory Committee for review and comment at the October 25, 2001, meeting. In addition, the requirements for prior authorization were developed with input from an expert panel, coordinated by the Pennsylvania Medical Society that included pharmacists, a consumer representative and physician specialties representing anesthesiology, addiction medicine, pain management, hematology/oncology and family practice.

Fiscal Impact

   The fiscal note was prepared under the authority of section 612 of The Administrative Code of 1929 (71 P. S.§ 232).

Contact Person

   A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. These comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office. Attention: Regulations Coordinator, Room 515 Health and WelfareBuilding, Harrisburg, PA 17120. Comments received will be considered in subsequent changes to these prior authorization requirements.

   Persons with a disability may use the AT&T Relay services by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Persons who require another alternative should contact Thomas Vracarich in the Office of Legal Counsel at (717) 783-2209.


   Fiscal Note:  14-NOT-309. No fiscal impact; (8) recommends adoption. Some cost savings are anticipated in the Medical Assistance--Outpatient appropriation.

[Pa.B. Doc. No. 01-2335. Filed for public inspection December 28, 2001, 9:00 a.m.]

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