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PA Bulletin, Doc. No. 11-911

NOTICES

Pharmacy Prior Authorization; Duplicate Therapy

[41 Pa.B. 2778]
[Saturday, May 28, 2011]

The Department of Public Welfare (Department) announces it will add duplicate therapy 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 prescription for a medication when there is a record of a recent paid claim for another drug within the same therapeutic class of drugs in the Department's pharmacy claims processing system.

 The Department will phase-in implementation of prior authorization of duplicate therapy and will issue MA Bulletins to providers enrolled in the MA Program specifying each class of drugs subject to a review for therapeutic duplication, the effective date of implementation and the procedures for obtaining prior authorization of prescriptions that are considered duplicate therapy. The first phase of implementation will be for drugs dispensed on or after June 6, 2011.

Fiscal Impact

 It is anticipated that these changes will result in savings of $9.292 million ($4.162 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2011-2012 and annualize savings of $10.137 million ($4.584 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).

GARY D. ALEXANDER, 
Acting Secretary

 Fiscal Note: 14-NOT-688. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 11-911. Filed for public inspection May 27, 2011, 9:00 a.m.]


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