Chapter 1121. Pharmaceutical Services  


Section 1121.1. Policy
Section 1121.2. Definitions
Section 1121.11. Types of services covered
Section 1121.12. Outpatient services
Section 1121.13. [Reserved]
Section 1121.14. Noncovered services
Section 1121.21. Scope of benefits for the categorically needy
Section 1121.22. Scope of benefits for the medically needy
Section 1121.23. Scope of benefits for State Blind Pension recipients
Section 1121.24. Scope of benefits for GA recipients
Section 1121.41. Participation requirements
Section 1121.42. Ongoing responsibilities of providers
Section 1121.51. General payment policy
Section 1121.52. Payment conditions for various services
Section 1121.52a. Clarification of the term ‘‘written’’—statement of policy
Section 1121.53. Limitations on payment
Section 1121.54. Noncompensable services and items
Section 1121.55. Method of payment
Section 1121.56. Drug cost determination
Section 1121.71. Scope of claims review procedures
Section 1121.81. Provider misutilization

Notation

Authority

   The provisions of this Chapter 1121 issued under sections 403, 443.4, 443.6 and 444.1 of the Public Welfare Code (62 P. S. § §  403, 443.4, 443.6 and 444.1), unless otherwise noted.

Source

   The provisions of this Chapter 1121 adopted May 9, 1980, effective May 10, 1980, 10 Pa.B. 1879; amended June 29, 1984, effective July 1, 1984, 14 Pa.B. 2257, unless otherwise noted. Immediately preceding text appears at serial pages (69587) to (69588), (62904) to (62911), (75063) to (75066) and (51215) to (51218).

Notes of Decisions

   Emergency regulations, which decreased Medicaid reimbursements to pharmacists who supply medications, were adopted in violation of a Federal act’s prohibition against compliant states from reducing payments for covered outpatient drugs. Pennsylvania Pharmaceutical Association v. Casey, 800 F.Supp. 173, 175 (M. D. Pa. 1992).

Cross References

   This chapter cited in 49 Pa. Code §  27.505 (relating to repositories); 55 Pa. Code §  1101.31 (relating to scope); 55 Pa. Code §  1101.95 (relating to conflicts between general and specific provisions); 55 Pa. Code §  1181.57 (relating to limitations on payment for prescription drugs); 55 Pa. Code §  1187.105 (relating to limitations on payment for prescription drugs); 55 Pa. Code §  1241.54 (relating to noncompensable services and items); and 55 Pa. Code §  6210.72 (relating to limitations on payment for prescription drugs).