This policy forum will be held at PCMS HQ this Wednesday, June 5 from 1 PM to 4 PM. The event is co-hosted by the Maternity Care Coalition (MCC) and Pennsylvania Health Access Network (PHAN). The keynote speaker is PA Secretary for Human Services, Teresa Miller.
If you are interested, please use the following registration link (please note space is limited).
https://pahealth.salsalabs.org/medicaidpolicyforum/index.html
Additionally, PAMED sent a message to all members at the end of May about the upcoming changes to Pennsylvania’s Department of Human Services’ plans to introduce a statewide preferred drug list (PDL) for Medicaid beneficiaries.
The state’s Medicaid programs, known as Medical Assistance (MA), will implement the statewide PDL on Jan. 1, 2020. The PDL will be used for fee-for-service and all the MA managed care organizations (MCOs).
DHS says the goal of the statewide PDL is to provide consistency in drug coverage for Medicaid beneficiaries and prevent disruption when a beneficiary moves from one plan to another.
Prior Authorization Requirements Under the Statewide PDL
Non-preferred drugs will remain available to MA beneficiaries when found to be medically necessary and all MA-covered drugs designated as non-preferred are covered but require prior authorization.
MCOs will be required to utilize the fee-for-service prior authorization guidelines to determine medical necessity of drugs and classes included on the PDL.
How to Comment on the Preferred Drug List
The state is accepting comments on the preferred drug list through this Friday, June 7, 2019. Physicians are encouraged to provide their input. You can use the links below to review the proposed guidelines:
- Acne Agents, Oral
- Angiotensin Modulators
- Antianginal Agents
- Antimalarials
- Antimigraine Agents, Other
- Antivirals, CMV
- Antivirals, Herpes
- Antivirals, Influenza
- Bone Density Regulators
- Cephalosporins
- Colony Stimulating Factors
- Dupixent (Dupilumab)
- HIV/AIDS Antiretrovirals
- Local Anesthetics, Topical
- Monoclonal Antibodies – Anti-IL, Anti-IgE (MABs – Anti-IL, Anti-IgE)
- Penicillins
- Thalidomide and Derivatives
- Urinary Anti-Infectives
- Vaginal Anti-Infectives
- Vitamin D Analogs
Comments on any of the proposed prior authorization requirements should be submitted via a Word document to [email protected]. The deadline is Friday, June 7.
