Pennsylvania’s Medicaid program will have a single statewide Preferred Drug List (PDL) effective Jan. 1, 2020. The statewide PDL was developed by the Department of Human Services (DHS) Pharmacy and Therapeutics (P&T) Committee and published via an Oct. 10, 2019 MA Bulletin. Officials with the Department of Human Services (DHS) report that requiring the Medicaid managed care plans to use a single medication formulary will result in substantial cost savings for the Medicaid program and improve consistency for providers and recipients.
- Under the statewide PDL, all Medicaid HealthChoices and Community HealthChoices plans as well as MA Fee-for-Service (FFS) will use the same list of preferred medications and the same prior authorization guidelines
- The DHS pharmacy director reported at a public meeting in late October that 149,741 consumers would be impacted by the transition, meaning they would need to change medications or get prior authorization to continue taking their current medication
- Of those impacted, about 39,000 would have more than one medication impacted
- Both FFS MA and the Medicaid managed care plans are scheduled to mail letters to impacted consumers by Nov. 1, 60 days prior to the effective date
- Medicaid consumers who get a letter about the new PDL should talk to their doctors about the preferred medication listed and will need prior authorization to have their current medication covered once the new PDL goes into effect in January
- The Medicaid MCOs are required to decide prior authorization requests within 24 hours
- Any Medicaid consumer who has a script denied at the pharmacy because the medication they have been taking now requires prior authorization can request a 15-day emergency supply, which is reimbursed by the MCO but provided at the discretion of the pharmacist
- Consumers who are denied a medication can contact the PHLP Helpline at 1-800-274-3258
More information on the Medicaid program PDL and the P&T Committee