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PA Bulletin, Doc. No. 05-105

NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program; Prior Authorization List

[35 Pa.B. 460]

   The purpose of this notice is to announce that the Department of Public Welfare (Department) will add an item to the Medical Assistance (MA) Program's list of services 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 prescriptions for Proton Pump Inhibitors (PPIs) dispensed on and after February 7, 2005, that meet any of the following conditions:

   1.  The prescription is for a PPI other than Prilosec Over-The-Counter (OTC), including prescription brand name Prilosec and generic Omeprazole.

   2.  The prescription is for Prilosec OTC and Prilosec OTC was prescribed for 4 months in the preceding 180 days.

   3.  The prescription for Prilosec OTC is for a quantity greater than 84 tablets per month, or a dosage greater than 40 mg per day, or both.

   Exception:  Prior authorization is not required for the following:

   1.  Oral liquid or IV forms of PPIs for recipients under 15 years of age and 65 years of age or older.

   2.  Omeprazole, 10 mg, limit one tablet per day.

   3.  Alternative preparations such as dissolvable or orally soluble forms of PPIs for recipients under 15 years of age.

Fiscal Impact

   The estimated savings for Fiscal Year 2004-2005 is $1.875 million ($0.879 million in State funds). The estimated savings for Fiscal Year 2005-2006 is $7.500 million ($3.449 million in State funds).

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department at the following address: Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office. Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent changes to these prior authorization requirements.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-407. No fiscal impact; (8) recommends adoption. This public notice provides for estimated savings to the Medical Assistance--Outpatient Appropria-tion of $879,000 during the remainder of Fiscal Year 2004-05 and $3.449 million for Fiscal Year 2005-06.

[Pa.B. Doc. No. 05-105. Filed for public inspection January 14, 2005, 9:00 a.m.]


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