Pharmacy Prior Authorization [42 Pa.B. 7350]
[Saturday, December 1, 2012]The Department of Public Welfare (Department) announces it will add Kalydeco and Korlym to the Medical Assistance (MA) Program's list of services and items requiring prior authorization. The Department will also add Hypoglycemics, TZDs designated as preferred on the Department's Preferred Drug List (PDL), and low dose oral atypical antipsychotics designated as preferred on the Department's PDL to the MA Program's list of services and items 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 all prescriptions for Kalydeco, Korlym and preferred Hypoglycemics, TZDs. The Department will also require prior authorization of prescriptions for preferred oral atypical antipsychotics prescribed in a low-dose for recipients 18 years of age and older beyond the first 60 days of therapy. These prior authorization requirements apply to prescriptions dispensed on or after December 3, 2012.
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 listed previously.
Fiscal Impact
These changes are estimated to result in savings of $1.651 million ($0.755 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2012-2013. Annualized savings of $3.301 million ($1.535 million in State funds) are estimated in FY 2013-2014.
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 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).
GARY D. ALEXANDER,
SecretaryFiscal Note: 14-NOT-802. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 12-2332. Filed for public inspection November 30, 2012, 9:00 a.m.]
