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.
A
- Acne Agents, Topical Fax Form v2.2022 (PDF)
- Alzheimers Agents Fax Form v1.2023 (PDF)
- Analgesics Opioid Long Acting Fax Form v2. July 2023 (PDF)
- Analgesics Opioid Short Acting Fax Form v2 July 2023 (PDF)
- Androgenic Agents Fax Form v1.2023 (PDF)
- Antibiotics, GI and Related Agents Fax Form v1.2023 (PDF)
- Anticoagulants Fax Form v1.2023 (PDF)
- Anticonvulsant Fax Form v1.2023 (PDF)
- Antidepressant, Other Fax Form v1.2023 (PDF)
- Antidepressant, SSRIs Fax Form v1.2023 (PDF)
- Antihypertensives, Sympatholytic Fax Form v1.2023 (PDF)
- Antihyperuricemic Fax Form v1.2023 (PDF)
- Antipsychotic Fax Form v1.2023 (PDF)
- Anxiolytics and Benzodiazepine Fax Form v1.2023 (PDF)
B
- Beta-Agonist Bronchodilator Fax Form v1.2023 (PDF)
- Bladder Relaxant Preparation Fax Form v1.2023 (PDF)
- Blood Glucose Meter and Test Strips Fax Form v1.2023 (PDF)
- Botulinum Toxins Fax Form v1.2023 (PDF)
C
- Cinacalcet Sensipar Fax Form v1.2023 (PDF)
- Colony Stimulating Factors Fax Form v1.2023 (PDF)
- Continuous Glucose Monitoring Fax Form v2.2022 (PDF)
- COPD Agent Fax Form v3.2022 (PDF)
- Cytokine and CAM Antagonists Fax Form v3.2022 (PDF)
D
E
H
I
- Influenza Antiviral Fax Form v2.2022 (PDF)
- Inhaled Glucocortoid Fax Form v3.2022 (PDF)
- Intra-Articular Hyaluronates Fax Form v2.2022 (PDF)
L
M
- Migraine Acute Treatment Agent Fax Form v1.2023 (PDF)
- Migraine Prevention Agent Fax Form v1.2023 (PDF)
- Modafinil Armondafinil Sunosi Wakix Fax Form v1.2023 (PDF)
- Monoclonal Antibodies-AntiL AntilgE Fax Form v1.2023 (PDF)
- Multiple Sclerosis Agents Fax Form v1.2023 (PDF)
N
- Neuropathic Pain Agent Fax Form v1.2023 (PDF)
- Non-Opiod Barbiturate Analgesic Combination Fax Form v1.2023 (PDF)
O
P
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:
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
2023
2022
- Q1 PT Meeting Minutes (PDF)
- Q2 PT Meeting Minutes (PDF)
- Q3 PT Meeting Minutes (PDF)
- Q4 PT Meeting Minutes (PDF)
2021
- Q1 PT Meeting Minutes (PDF)
- Q2 PT Meeting Minutes (PDF)
- Q3 PT Meeting Minutes (PDF)
- Q4 PT Meeting Minutes (PDF)
2020
- Q1 PT Meeting Minutes (PDF)
- Q2 PT Meeting Minutes (PDF)
- Q3 PT Meeting Minutes (PDF)
- Q4 PT Meeting Minutes (PDF)
2019
- Q1 PT Meeting Minutes (PDF)
- Q2 PT Meeting Minutes (PDF)
- Q3 PT Meeting Minutes (PDF)
- Q4 PT Meeting Minutes (PDF)