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Pennsylvania Prescription Drug Coverage

Provider Alerts

As of June 1st, 2019, PA Health and Wellness switched over to a new pharmacy claims processor for Community HeathChoices. Please note the following changes: the BIN will be 020545; the PCN will be RXA373; and the GRP will be RXGMCPA01. Additionally, the fax number for medication prior authorizations will change to 1-877-386-4695.

PA Health and Wellness Prescriber Lunch and Learn Series

In 2021 our PA Health and Wellness (PHW) Pharmacy Team will be virtually “opening our offices” to our Network Prescribers to offer educational “Lunch and Learns.” We will use these forums to update you on pharmacy benefits, program changes, and facilitate open discussion! We invite you to also ask any questions that you might have during these forums so we may better assist you in providing high-quality care to your Patients, our Participants. 

Our Prescriber Lunch and Learns will occur on the 4th Tuesday of each month in 2021 starting on February 23, 2021. Register online today.

PHW is committed to providing appropriate, high-quality, and cost-effective drug therapy to all PA Health and Wellness Participants. We, at PHW, want to help you navigate our plan pharmacy benefits in order to better explain to our Participants what they need to do in order to obtain care they need without unnecessary barriers. This will include all PA Health and Wellness products: PA Health and Wellness (Community HealthChoices), Allwell from PA Health and Wellness (Medicare D-SNP and Advantage Plan), and Ambetter from PA Health and Wellness (Commercial Exchange).

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.

General PA Forms

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)

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).