Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 8238 (December 30, 2023).

55 Pa. Code § 1121.11. Types of services covered.

COVERED AND NONCOVERED SERVICES


§ 1121.11. Types of services covered.

 (a)  The MA Program covers legend drugs except as otherwise specified in this chapter if the medical necessity has been established and the drug has been prescribed or ordered by a licensed prescriber within the scope of the prescriber’s practice.

 (b)  The MA Program covers the nonlegend drugs specified in §  1121.53(d) (relating to limitations on payment), except that for GA recipients, coverage of nonlegend drugs is limited to insulin and drugs that the Department has identified as the preferred drug in a therapeutic class.

 (c)  Payment is subject to the conditions and limitations of this chapter and Chapter 1101 (relating to general provisions).

Authority

   The provisions of this §  1121.11 amended under sections 201(2), 403(b), 443.4 and 454 of the Public Welfare Code (62 P. S. § §  201(2), 403(b), 443.4 and 454).

Source

   The provisions of this §  1121.11 amended August 5, 2005, effective August 10, 2005, 35 Pa.B. 4309. Immediately preceding text appears at serial page (251190).

Cross References

   This section cited in 55 Pa. Code §  1124.24 (relating to scope of benefits for GA recipients).



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