§ 4220.12. Limitations.
(a) Drugs in the following general categories may be reimbursed by the county mental health and intellectual disability program.
(1) Major tranquilizers. Includes:
(i) Phenothiazines.
(ii) Butyrophenones.
(iii) Thioxanthenes.
(iv) Rauwolfia Alkaloids.
(v) Dibenzoxazepines.
(vi) Molindones.
(2) Minor tranquilizers. Includes:
(i) Propanediole.
(ii) Benzodiazepines.
(iii) Diphenylmethane Derivatives.
(3) Hypnotics and sedatives. Includes:
(i) Barbiturates.
(ii) Nonbarbiturates.
(4) Antidepressants. Includes:
(i) Tricyclics.
(ii) Monomine Oxidase Inhibiters.
(iii) Lithium.
(5) Central nervous system stimulants.
(6) Anticonvulsant agents.
(7) Antiparkinsonian agents.
(8) Various geriatric psychotropic agents.
(b) The county mental health and intellectual disability program may also reimburse for an item not falling in the general categories listed in subsection (a)(1)—(8) if, in the licensed practitioner’s professional opinion, it is essential for the present treatment of the patient’s mental disorder. The county mental health and intellectual disability program may require, as a condition of reimbursement for these items, that prior approval be given by the County MH/ID Program. Where prior approval is required, it is the responsibility of the county administrator to ensure that proper notification of approval be given to the pharmacy at the time the prescription is presented to be filled.
(c) An initial prescription is limited to a 45-day supply and a maximum of one refill may be requested on an initial prescription. The quantity dispensed on the refill prescription cannot exceed the quantity prescribed on the initial prescription.
(d) The County MH/ID Program’s maximum rate of reimbursement for drugs is the pharmacy’s usual and customary charges to the general public for psychotropic drugs. Discounts given to special groups such as senior citizens must also be given to County MH/ID clients who are members of those specialized groups.
Authority The provisions of this § 4220.12 amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § § 4201(2) and (8) and 4202).
Source The provisions of this § 4220.12 amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (247750) to (247751).
Cross References This section cited in 55 Pa. Code § 4220.14 (relating to cost and quality control measures).
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