Pharmacy Prior Authorization [41 Pa.B. 6456]
[Saturday, December 3, 2011]The Department of Public Welfare (Department) announces it will add Antipsychotics to the Medical Assistance (MA) Program's list of services and items requiring prior authorization when designated as preferred on the Department's Preferred Drug List and prescribed for recipients 6 to 18 years of age. The Department currently requires prior authorization of preferred Antipsychotics when prescribed for recipients under 6 years of age and is extending that requirement to include all recipients under 18 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 Department will phase-in implementation of prior authorization of preferred Antipsychotics and will issue MA Bulletins to providers enrolled in the MA Program specifying each age group of recipients, the effective date of implementation and the procedures for obtaining prior authorization of prescriptions. Phase 1 of implementation will be for preferred Antipsychotics dispensed on or after January 9, 2012, to recipients 6 years of age or older but under 12 years of age. Phase 2 of implementation will be for preferred Antipsychotics dispensed on and after February 13, 2012, to recipients 12 years of age or older but under 16 years of age. Phase 3 will be for preferred Antipsychotics dispensed on and after April 4, 2012, to recipients 16 years of age or older but under 18 years of age.
Fiscal Impact
It is anticipated that this change will result in savings of $0.717 million ($0.322 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2011-2012. Annualized savings of $1.098 million ($0.500 million in State funds) are estimated for FY 2012-2013.
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-733. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-2066. Filed for public inspection December 2, 2011, 9:00 a.m.]
