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Pennsylvania Prescription Drug Coverage

Provider Alerts

As of June 1st, PA Health and Wellness will be switching our pharmacy claims processor for Community HeathChoices and participants will get a new ID card by mail. 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.

As of June 1st, any opioid prescription over 50 morphine milligram equivalents (MME) per day will require a prior authorization.  As a reminder, any days’ supply over five also requires a prior authorization.  See our pharmacy policies for instances when a prior authorization may not be necessary.

Opioid Letter to Physicians (PDF)

Preferred Drug List Notification

The January 1st, 2020 implementation of the statewide, uniform preferred drug list (PDL) can be found on the DHS website.

From PA Health & Wellness

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

PA Health & Wellness Prescriber Lunch & Learn Series

In 2021 our PA Health & Wellness (PHW) Pharmacy Team will be virtually “opening our offices” to our Network Prescribers to offer educational “Lunch & 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 & 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 & 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 & Wellness products: PA Health & Wellness (Community HealthChoices), Allwell from PA Health & Wellness (Medicare D-SNP and Advantage Plan), and Ambetter from PA Health & Wellness (Commercial Exchange).

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 9/2020 (PDF)

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 & Wellness Policies

Medication Specific PA Forms

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

Filling Prescriptions for Extended Day Supply

PA Health & 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 & Wellness, download the Contracted Specialty Pharmacies document (PDF).