Medical Assistance Program; Prior Authorization List [35 Pa.B. 2827] This notice announces that the Department of Public Welfare (Department) will add an item to the Medical Assistance (MA) Program's list of items and services 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 prescriptions, including refills, for brand name single source Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) dispensed on and after May 16, 2005. The specific drugs that will require prior authorization are Arthrotec (diclofenac/misoprostol) and Mobic (meloxicam).
Exception
Prior authorization of a prescription for Mobic is not required if the Department has a record of paying for two or more generic NSAIDs within the past 180 days for the reicipient.
The Department will require prior authorization of prescriptions for new brand name single source NSAIDs when they become available in the marketplace.
Fiscal Impact
Due to the claims processing time lag, no savings are anticipated in Fiscal Year (FY) 2004-2005. For FY 2005-2006, savings are estimated at $0.259 million ($0.119 million in State funds).
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 Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent changes to these prior authorization requirements.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-419. No fiscal impact; (8) recommends adoption. Implementation of the notice will generate savings to the General Fund beginning in FY 2005-2006. These savings have been included in the Governor's 2005-2006 proposed budget.
[Pa.B. Doc. No. 05-900. Filed for public inspection May 6, 2005, 9:00 a.m.]
