COVERED AND NONCOVERED SERVICES

1. (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.
2. (b) The MA Program covers nonlegend drugs as specified in § 1121.53(d) (relating to limitations on payment).
3. (c) Payment is subject to the conditions and limitations of this chapter and Chapter 1101 (relating to general provisions).

Authority

The provisions of this § 1121.11 amended under sections 201(2), 403(b), 403.1(a)(4), 443.4 and 454 of the Human Services Code (62 P.S. § § 201(2), 403(b), 403.1(a)(4), 443.4 and 454).

Source

The provisions of this § 1121.11 amended August 5, 2005, effective August 10, 2005, 35 Pa.B. 4309; amended January 2, 2026, effective January 3, 2026, 56 Pa.B. 16. Immediately preceding text appears at serial pages (422710) and (361027).

Cross References

This section cited in 55 Pa. Code § 1124.24 (relating to scope of benefits for GA recipients).