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March 1, 2013 - February 28, 2014
Pennsylvania has developed a preferred drug list for its fee-for-service pharmacy beneficiaries to ensure that Medical Assistance consumers receive effective medical care with consistent quality and optimal results from the drugs that are prescribed for them. Experience in other states has proven that the preferred drug list is an effective tool in helping states address the escalating cost of pharmacy services in an efficient and economical manner, while maintaining access to clinically effective drugs, patient safety and quality of care.
When considering medications for Pennsylvania Medical Assistance consumers, providers should try to choose drugs that are on the list. Drugs not on the preferred drug list will remain available to Medical Assistance consumers when determined to be medically necessary (see non-preferred drug section below).
The drugs that are included on the preferred drug list are those drugs that are determined by the Pharmacy and Therapeutics Committee to be the best in a particular class based on: clinical effectiveness, safety and outcomes. When all drugs in a class are therapeutically equivalent, then the cost of the drug, including rebates will be considered. Some preferred drugs may require clinical prior authorization to ensure appropriate use and patient safety.
Non-preferred drugs remain available to MA consumers when found to be medically necessary and require prior authorization before the prescriptions can be acquired at the pharmacy.
Pharmacy Frequently Asked Questions (FAQs)
The Department of Public Welfare has teamed up with Provider Synergies, LLC to provide consultation and support for the Pharmacy and Therapeutics Committee and the department's preferred drug list.
The latest version of the PDL can be found on the Provider Synergies L.L.C. website. The Provider Synergies website provides information on the following items: