Pharmacy Prior Authorization
[49 Pa.B. 7254]
[Saturday, December 7, 2019]
The Department of Human Services (Department) announces it will add Hemangeol (propranolol oral solution), Prevymis (letermovir), Sublocade (buprenorphine), Acne Agents, Oral, Antihemophilia Agents, Iron Chelating Agents, Potassium Removing Agents, Thrombopoietics, Enzyme Replacements, Gaucher Disease, and Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled designated as preferred on the Department's Preferred Drug List, and Ultomiris (ravulizumab) to the Medical Assistance (MA) Program's list of services and items requiring prior authorization.
Section 443.6(b)(7) of the Human Services 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 Hemangeol (propranolol oral solution), Prevymis (letermovir), Sublocade (buprenorphine), Ultomiris (ravulizumab), Acne Agents, Oral, Antihemophilia Agents, Iron Chelating Agents, Potassium Removing Agents, Thrombopoietics, Enzyme Replacements, Gaucher Disease, and Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled. These prior authorization requirements apply to prescriptions dispensed on or after January 1, 2020.
The Department has issued MA Bulletins to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of prescriptions for each of the medications previously listed.
These changes are estimated to result in minimal savings to the MA Program.
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1373. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 19-1817. Filed for public inspection December 6, 2019, 9:00 a.m.]
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