Skip to Main Content
Contrast
a a a

Pennsylvania Prescription Drug Coverage

Provider Alerts

On March 1st, 2022, our Community HealthChoices (Pennsylvania Medicaid) plan will switch over to CVS for our pharmacy claims processor. To ensure a smooth transition, all Medicaid members should update their pharmacy with their new ID card that they received in the mail. Please note the following changes:

BIN: 004336
PCN: MCAIDADV
GRP: RX5455

For claims related issues, the CVS Help Desk can be reached at 1-888-321-3120.

Additionally, the fax number for medication prior authorizations will change to 1-844-205-3386.

Please note that this update applies to CHC or Pennsylvania Medicaid only. This switch in pharmacy platforms should not impact any member's current pharmacy benefits. If you have additional questions, you can reach out to PHW member services at 1-844-626-6813.

From PA Health and Wellness

PA Health and Wellness is committed to providing appropriate, high-quality, and cost-effective drug therapy to all PA Health and Wellness participants. PA Health and Wellness’s Pennsylvania prescription insurance covers prescription medications and certain over-the-counter medications with a written order from a PA Health and Wellness provider.

This Pennsylvania prescription drug coverage program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

Electronic Prior Authorization Submissions

Submit your prior authorization (PA) requests electronically through CoverMyMeds.

Electronic prior authorization (ePA) automates the PA process making it a simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations. 

For select drugs and plans, CoverMyMeds may issue immediate approval of your request and updtae your patient PA record to allow immediate claim adjudication.

General PA Forms

Medicaid CHC Medication Specific PA Forms

Below, please find medication specific prior authorization forms that align with our approved prior authorization policies.

Pharmacy Policies

To access, view or download an active Pharmacy Policy for a covered drug on the Pennsylvania Medical Assistance Program's Statewide Preferred Drug List (PDF) or the PHW Supplemental Drug List, visit the following:

PA Health and Wellness Policies

Preferred Drug List (PDL) 

To download a listing of covered drugs or search the PDL by drug, visit the Pennsylvania Department of Human Services web portal and select:

Pennsylvania Medical Assistance Program's Statewide Preferred Drug List (PDL)

PHW Supplemental Drug List

Download the PHW Supplemental Drug List (PDF)

PHW Specialty Medication List

Download the PHW Specialty Medication List (PDF)

Filling Prescriptions for Extended Day Supply

PA Health and Wellness members may fill prescriptions for certain maintenance medications for up to a 90 day supply at participating pharmacies. To see which medications are eligible to be filled for extended day supply and which pharmacies participate in the extended day supply program, click the links below or contact a customer service representative at 1-844-626-6813 (TTY 1-844-349-8916):

Specialty Pharmacies

To view the list of Specialty Pharmacies with PA Health and Wellness, download the Contracted Specialty Pharmacies document (PDF).

DEA National Take Back Prescription Drug Program

Learn more about the DEA National Take Back program, and find an authorized collector in your area with the DEA National Take Back Prescription Online Resource.

Pharmacy and Therapeutics Committee Meeting Minutes 

2022

2021

2020

2019

2018