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Payment conditions for various services - 55 Pa. Code § 1121.52

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Medical assistance prescriptions must contain the following information on the prescription form:1

  •         The patient’s name and address;
  •         The name of the licensed prescriber;
  •         The name, strength and quantity of the medication;
  •         The directions for use;
  •         The number of refills, if any;
  •         The indication for “brand medically necessary” when applicable;
  •         The DEA number of the licensed provider, when controlled substances have been prescribed; and
  •         The professional license number of the licensed prescriber.



  • 1. 55 Pa. Code Chapter 1121, “Payment condition for various services” 55 Pa. Code § 1121.52

Current as of June 2015