Pharmacy

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

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:

 

Pharmacy Prior Authorization General Requirements

Information concerning the following topics are posted on the Pennsylvania Department of Human Services web portal.

  • 5-Day Supplies Without Prior Authorization
  • Automated Prior Authorization Approvals
  • Clinical Review Process
  • Denials
  • Documentation Supporting the Need for a Prescription That Requires Prior Authorization
  • Dose and Duration of Therapy
  • Information and Supporting Documentation Required for the Prior Authorization Review
  • Initiating the Prior Authorization Request
  • Notice of Decision
  • Prescriptions That Require Prior Authorization
  • Prior Authorization Number
  • Review of Documentation for Medical Necessity
  • Timeframe of Review
  • Where and When to Call
  • Who May Initiate the Request