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PA Bulletin, Doc. No. 09-1296


Pharmacy Prior Authorization

[39 Pa.B. 4181]
[Saturday, July 18, 2009]

Purpose of Notice

   The Department of Public Welfare (Department) announces additions to the Medical Assistance (MA) Program's list of services and items requiring prior authorization, effective August 3, 2009:

   *  Neulasta

   *  Suboxone, except the initial prescription

   *  Subutex, except the initial prescription

   *  Cough and cold medications when prescribed for children under 6 years of age

   *  Benzodiazepines when prescribed for children under 21 years of age

   *  Topical acne agents with the potential for cosmetic use, such as those with an active ingredient of topical tretinoin, adapaline, azelaic acid or tazarotene, when prescribed for adults 21 years of age or older.

   In accordance with 42 U.S.C.A. § 1396r-8(d)(2)(C) (relating to payment for covered outpatient drugs) the MA Program may exclude or restrict coverage for agents when used for cosmetic purposes.

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

   The MA Program will require prior authorization of prescriptions for the medications listed previously that are dispensed on or after August 3, 2009.

   The Department will issue MA Bulletins to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of prescriptions for the medications listed previous.

Fiscal Impact

   It is estimated that the prior authorization requirement for these drugs will result in savings of $0.736 million ($0.298 million in State funds) in Fiscal Year 2009-2010 and annualized savings of $0.883 million ($0.400 million in State funds) in Fiscal Year 2010-2011. These State fund estimates are based on the increased Federal Medical Assistance Percentages as determined under American Recovery and Reinvestment Act (ARRA) of 2009.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department at the following address: Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions to these prior authorization requirements.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note: 14-NOT-611. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 09-1296. Filed for public inspection July 17, 2009, 9:00 a.m.]

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