Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 7346 (November 25, 2023).

55 Pa. Code § 1121.51. General payment policy.

PAYMENT FOR PHARMACEUTICAL SERVICES


§ 1121.51. General payment policy.

 Payment is made for covered pharmaceutical services provided by participating pharmacies subject to the conditions and limitations in this section and § §  1121.52—1121.56 and Chapter 1101 (relating to general provisions). Payment will not be made for a compensable pharmaceutical service if payment is available from another public agency or another insurance or health program. This does not apply to MA recipients whose drugs have been prescribed through the County Mental Health/Mental Retardation Programs operated under the Mental Health and Mental Retardation Act of 1966 (50 P. S. § §  4101—4704). In this instance only, providers may bill the MA Program for services as specified in this chapter.

Cross References

   This section cited in 55 Pa. Code §  1121.54 (relating to noncompensable services and items).



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