Pennsylvania Limits Prescriptions To Six Per Month for FFS Medicaid Beneficiaries

Share Starting January 1, 2012, Pennsylvanians eligible for fee-for-service (FFS) Medicaid medical assistance will be limited to six prescriptions per month. The Pennsylvania Department of Welfare (DPW) proposed the limit in March 2011 as a budget savings measure. Medicaid managed care organization (MCO) capitation rates were reduced to reflect the prescription drug limit; however the MCOs have discretion about implementing the limit. DPW included an exception process, a list of medical conditions not subject to the limit, and exempted certain populations from the limit. Details about these exceptions are as follows: The exceptions process permits physicians to request . . .