Pa. Medicaid Program’s Statewide Preferred Drug List Took Effect Jan. 1, 2020
Last Updated: Jan 1, 2020
Pennsylvania’s Medicaid programs, known as Medical Assistance (MA), implemented a statewide preferred drug list (PDL) on Jan. 1, 2020.
The PDL is used for both fee-for-service (FFS) and all MA managed care organizations (MCOs) in Physical Health HealthChoices and Community HealthChoices.
Key details on how the new statewide PDL works include:
- The preferred or nonpreferred status of drugs included in the PDL applies to both FFS and MCOs.
- Prior authorization guidelines for drugs included in the PDL apply to FFS and managed care delivery systems.
- The MCOs may, but are not required to, require prior authorization of drugs that are subject to quantity limits in the FFS system.
- MCOs have the ability to designate drugs as preferred or non-preferred in drug classes that are not included on the statewide PDL.
- A temporary supply is available if an MA beneficiary's prescription for a medication is not filled when the prescription is presented to the pharmacist due to a prior authorization requirement.
The Pennsylvania Department of Human Services (DHS) offers a PDL webpage here.
Prior Authorization Requirements
For details on FFS prior authorization requests, check out these DHS resources:
For details on submitting prior authorization requests to MCOs, providers should contact the MCOs for MCO-specific information.