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PA Bulletin, Doc. No. 08-1640



Medical Assistance Program; Prior Authorization List

[38 Pa.B. 4960]
[Saturday, September 6, 2008]

   The Department of Public Welfare (Department) announces additions to the Medical Assistance (MA) Program's list of services and items requiring prior authorization, effective September 15, 2008:

*  Letairis
*  Methadone
*  Myobloc (Botulinum Toxin Type B)
*  Atypical antipsychotics when two or more are prescribed for 60 days or more
*  Atypical antipsychotics when prescribed for children under 6 years of age
*  Stimulants and related agents when prescribed for children under 4 years of age
*  Over-The-Counter (OTC) cough and cold medications when prescribed for children under 2 years of age

   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 the medications listed previously that are dispensed on and after September 15, 2008.

   The Department will issue MA Bulletins to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of the prescriptions for the medications listed previously.

Fiscal Impact

   It is estimated that the change will result in savings of $0.013 million ($0.006 million in State funds) in the MA-Outpatient Program in Fiscal Year (FY) 2008-2009 and annualized net savings of $0.017 million ($0.008 million in State funds) in FY 2009-2010.

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 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 revisions 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).


   Fiscal Note: 14-NOT-568. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 08-1640. Filed for public inspection September 5, 2008, 9:00 a.m.]

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