Pennsylvania Implements Preferred Drug List

January 2020 ~

Pennsylvania’s Medical Assistance Program implemented a statewide Preferred Drug List (PDL) to be utilized by the fee-for-service program and all eight Medical Assistance (MA) managed care organizations (MCOs) in the state.

As of January 1, the Pennsylvania’s Department of Human Services (the Department) is requiring that companies that manage pharmacy benefits for state Medicaid recipients rely on a unified PDL list. The new list applies to around one-third of the approximate 2,650 medications covered by Medicaid and could result in an estimated 150,000 of the state’s 2.8 million Medicaid recipients to switch to new medications, according to state officials.

Preferred Drugs

According to the Department, the drugs that are designated as preferred on the Statewide PDL are those that are determined by the Department’s Pharmacy & Therapeutics (P&T) Committee to be the best in a particular class based on effectiveness, safety, and clinical outcomes. When all drugs in a class are clinically equivalent, the cost of the drug including rebates will be considered. Some preferred drugs require clinical prior authorization to ensure appropriate use and patient safety.

 Non-Preferred Drugs

Non-preferred drugs remain available to MA beneficiaries when found to be medically necessary. All drugs designated as non-preferred require prior authorization before the prescriptions may be dispensed at the pharmacy. Refer to the Pharmacy Prior Authorization Clinical Guidelines relating to the corresponding PDL class of drugs.

In an effort to mitigate potential barriers to care brought on by the implementation of the new PDL, Pennsylvania DHS mandated all eight MA companies to send out letters in October to notify the affected consumers of the change to their medication plans. The letter advised patients to consult with their primary care physician about the pros and cons around switching prescriptions.

The Department estimates that the new approach has the potential to save the state $85 million a year.

For more information, refer the Pharmacy Prior Authorization General Information and Pharmacy Prior Authorization Clinical Guidelines pages.

Source(s): Pennsylvania Department of Human Services; WHYY PA; Philadelphia Inquirer; Morning Call; Levittown NOW; PennLIVE;