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PA Bulletin, Doc. No. 11-1772



Pharmacy Prior Authorization

[41 Pa.B. 5603]
[Saturday, October 15, 2011]

 The Department of Public Welfare (Department) announces it will add stimulants and related agents designated as preferred on the Department's Preferred Drug List when prescribed for recipients 18 years of age and older to the Medical Assistance (MA) Program's list of services and items requiring prior authorization.

 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 Department will phase-in implementation of prior authorization of preferred stimulants and related agents and will issue MA Bulletins to providers enrolled in the MA Program specifying each age group of recipients, the effective date of implementation and the procedures for obtaining prior authorization of prescriptions. The first phase of implementation will be for preferred stimulants and related agents dispensed on or after October 17, 2011, to recipients 18 years of age or older but under 27 years of age. The second phase of implementation will be for preferred stimulants and related agents dispensed on and after November 14, 2011, to recipients 27 years of age and older.

Fiscal Impact

 These changes are estimated to result in savings totaling $0.399 million ($0.181 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2011-2012. Savings are estimated $ 0.685 million ($0.312 million in State funds) in FY 2012-2013.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the 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 Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-722. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 11-1772. Filed for public inspection October 14, 2011, 9:00 a.m.]

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