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PA Bulletin, Doc. No. 16-54


Pharmacy Prior Authorization

[46 Pa.B. 297]
[Saturday, January 9, 2016]

 The Department of Human Services (Department) announces it will add the following medications designated as preferred on the Department's Preferred Drug List to the Medical Assistance (MA) Program's list of services and items requiring prior authorization:

 • Alzheimers Agents

 • Cholbam

 • Hepatitis C Agents

 • Tiotropium when prescribed for an indication of asthma

 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 all prescriptions for the medications previously listed. These prior authorization requirements apply to prescriptions dispensed on or after January 20, 2016.

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

Fiscal Impact

 These changes are estimated to result in savings totaling $0.627 million ($0.301 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2015-2016. Savings are estimated $2.507 million ($1.208 million in State funds) in FY 2016-2017.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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).


Fiscal Note. 14-NOT-988. (1) General Fund; (2) Implementing Year 2015-16 is −$301,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are −$1,208,000; (4) 2014-15 Program—$348,741,000; 2013-14 Program—$264,179,000; 2012-13 Program—$450,835,000; (7) MA—Outpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 16-54. Filed for public inspection January 8, 2016, 9:00 a.m.]

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