Current through Register Vol. 54, No. 49, December 7, 2024
Section 1121.11 - Types of services covered(a) The MA Program covers legend drugs except as otherwise specified in this chapter if the medical necessity has been established and the drug has been prescribed or ordered by a licensed prescriber within the scope of the prescriber's practice.(b) The MA Program covers the nonlegend drugs specified in § 1121.53(d) (relating to limitations on payment), except that for GA recipients, coverage of nonlegend drugs is limited to insulin and drugs that the Department has identified as the preferred drug in a therapeutic class.(c) Payment is subject to the conditions and limitations of this chapter and Chapter 1101 (relating to general provisions).The provisions of this § 1121.11 amended August 5, 2005, effective 8/10/2005, 35 Pa.B. 4309.The provisions of this § 1121.11 amended under sections 201(2), 403(b), 443.4 and 454 of the Public Welfare Code (62 P. S. §§ 201(2), 403(b), 443.4 and 454).
This section cited in 55 Pa. Code §1124.24 (relating to scope of benefits for GA recipients).