1. (a) MA prescriptions, including those for recipients in skilled nursing facilities, intermediate care facilities or intermediate care facilities for individuals with intellectual disabilities, which are either written, electronic or verbally ordered by a licensed prescriber shall contain on the prescription:

   1. (1) The name and address of the patient.
   2. (2) The name of the licensed prescriber.
   3. (3) The name, strength and quantity of the medication.
   4. (4) The directions for use.
   5. (5) The number of refills, if any.
   6. (6) The indication for ‘‘brand medically necessary’’, when applicable, as specified in § 1121.53(b) (relating to limitations on payment).
   7. (7) The DEA number of the licensed prescriber, when controlled substances have been prescribed.
   8. (8) The National Provider Identifier (NPI) of the licensed prescriber.

2. (b) {Reserved}.

   (b.1) Compensable pharmaceutical services that require prior authorization shall be authorized by publication of notice in the Pennsylvania Bulletin and listed on the Department’s website. Providers must follow the procedures as set forth in § 1101.67 (relating to prior authorization) to ensure appropriate and timely processing of prior authorization requests for compensable pharmaceutical services that require prior authorization.

3. (c) For payment to be made for filling altered prescriptions, the pharmacy shall certify in writing on the prescription that the change was made by the licensed prescriber. Changes in the nature or brand of a medication, the strength of a medication, directions or quantity dispensed are acceptable only if the consent of the licensed prescriber was obtained before dispensing. The written explanation of the pharmacy on the prescription must state that this was done and give the reasons for the change.

Authority

The provisions of this § 1121.52 amended under sections 201(2) and 403.1(a)(4) of the Human Services Code (62 P.S. § § 201(2) and 403.1(a)(4)).

Source

The provisions of this § 1121.52 amended January 2, 2026, effective January 3, 2026, 56 Pa.B. 16. Immediately preceding text appears at serial page (422711).

Cross References

This section cited in 55 Pa. Code § 1121.51 (relating to general payment policy); 55 Pa. Code § 1121.52a (relating to clarification of the term ‘‘written’’—statement of policy); and 55 Pa. Code § 1121.54 (relating to noncompensable services and items).