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PA Bulletin, Doc. No. 11-1773


Pharmacy Prior Authorization

[41 Pa.B. 5604]
[Saturday, October 15, 2011]

 The Department of Public Welfare (Department) announces it will add Xyrem 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 MA Program will require prior authorization of all prescriptions for Xyrem dispensed on or after October 17, 2011.

 The Department will issue an MA Bulletin to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of prescriptions for the medication listed previously.

Fiscal Impact

 These changes are estimated to result in savings totaling $0.042 million ($0.019 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2011-2012. Savings are estimated $0.073 million ($0.033 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-723. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 11-1773. Filed for public inspection October 14, 2011, 9:00 a.m.]

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