Pharmacy Prior Authorization
[41 Pa.B. 4817]
[Saturday, September 3, 2011]
The Department of Public Welfare (Department) announces it will be requiring prior authorization of refills of prescriptions when more than 15% of an earlier-dispensed medication would remain when taken in compliance with directions and quantity prescribed. The Department currently requires prior authorization of refills when more than 25% of an earlier-dispensed medication would remain when taken in compliance with the directions and quantity prescribed. See 38 Pa.B. 4038 (July 26, 2008).
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 Medical Assistance (MA) Program will require prior authorization for all refills dispensed on or after September 12, 2011, when more than 15% of an earlier-dispensed medication would remain when taken in compliance with the directions and quantity prescribed. For a 30-day supply of a medication, more than 15% remaining when taken in compliance with the directions and quantity prescribed equals a 5-day supply or more remaining.
The Department will issue an MA Bulletin to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of early refills of prescriptions.
These changes are estimated to result in savings totaling $0.594 million ($0.269 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2011-2012. Savings are estimated $1.019 million ($0.464 in State funds) for FY 2012-2013.
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).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-712. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-1515. Filed for public inspection September 2, 2011, 9:00 a.m.]
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