According to state officials, Pennsylvania’s Medicaid program transitioned to a single statewide Preferred Drug List (PDL) on January 1, 2020, without any major problems. According to the DHS pharmacy director, some pharmacies reported availability problems for one generic form of Concerta (a stimulant), but other generics are also preferred and widely available. As we reported in October (here), the change away from the Medicaid managed care plans all using separate formularies to a uniform PDL was expected to impact almost 150,000 Medicaid consumers. Affected consumers should have received a letter discussing the change in November. They will need prior authorization to get medications that are no longer “preferred.”
Medicaid consumers who have a prescription denied at the pharmacy because they lack prior authorization should ask for a 15-day emergency supply. These temporary supplies are provided at the discretion of the pharmacist. Consumers who are denied a medication by their managed care plan can contact the PHLP Helpline at 1-800-274-3258.