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PA Bulletin, Doc. No. 19-90



Pharmacy Prior Authorization

[49 Pa.B. 343]
[Saturday, January 19, 2019]

 The Department of Human Services (Department) announces it will add Radicava (edaravone) and Symdeko (tezacaftor/ivacaftor) to the Medical Assistance (MA) Program's list of services and items requiring prior authorization.

 Section 443.6(b)(7) of the Human Services 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 Radicava (edaravone) and Symdeko (tezacaftor/ivacaftor). These prior authorization requirements apply to prescriptions dispensed on or after January 22, 2019.

 The Department will issue MA Bulletins to providers enrolled in the MA Program specifying the procedures for obtaining prior authorization of prescriptions for Radicava (edaravone) and Symdeko (tezacaftor/ivacaftor).

Fiscal Impact

 These changes are estimated to result in minimal savings in the MA Fee-for-Service Program.

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-1303. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 19-90. Filed for public inspection January 18, 2019, 9:00 a.m.]

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