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OMAP Responds to Prior Authorization Barriers
February 6, 2012

The Office of Medical Assistance Programs (OMAP) is aware of difficulties with implementation of prior authorization requirements that have delayed the authorization process. A convergence of prior authorization requirements and benefit limit questions has increased call volume beyond the normal capacity of the Pharmacy Services Call Center. OMAP plans to implement a form for approval of antipsychotic medications for children in mid-February.

Forms that capture changes resulting from Pharmacy and Therapeutics Committee recommendations made during the November 2011 meeting that are scheduled for implementation February 13 are available at http://www.dpw.state.pa.us/publications/index.htm. Select “OMAP” and “Form” for a list of available forms (e.g., Antidepressants, SSRI and Stimulants and Related Agents). Providers are to fax the form and supporting documentation, cutting down some of the call volume. New staff is being added to the call center. OMAP anticipates that these changes will speed the prior authorization response time.

Individuals can receive an emergency supply of medications. Medical Assistance pays pharmacies for the emergency supply. If a determination is not received before the emergency supply is exhausted, a second emergency supply may be issued at the discretion of the clinician. Although allowed, this process may be unwieldy and difficult for individuals and providers to utilize effectively.

Although these changes should help with access to the prior authorization process, PCPA continues to advocate for specialist discretion in prescribing behavioral health medications and against a six-prescription monthly limit for medications for many individuals. Please continue to notify Betty Simmonds (betty@paproviders.org) of issues that arise related to barriers to accessing needed medications.

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