Pa. Medicaid Program’s Statewide Preferred Drug List Took Effect Jan. 1, 2020

Last Updated: Jan 1, 2020

pills-stethoscope-prescriptionPennsylvania’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.

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