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On June 20, 2024, UnitedHealth Group issued a press release offering an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. While the investigation to determine whose data is impacted is not yet complete, UnitedHealth Group has started the process to notify impacted customers and shared a website that provides additional information. UnitedHealth Group continues to offer credit monitoring and identity protection services, as well as a dedicated contact center to address questions. You can learn more about the support resources by visiting Change Healthcare Cyberattack Support and/or by reaching out to the contact center at 1-866-262-5342 with any questions. 

Pharmacy

Provider Alerts

In 2024, our Community HealthChoices Plan (Pennsylvania Medicaid) switched over to Express Scripts for our Pharmacy Benefits Manager. Please note the following:

Community HealthChoices (CHC)

BIN: 003858
PCN: MA
GRP: 2FBA

For claims related issues, the Express Scripts Pharmacy Help Desk can be reached at 1-833-750-4504.

The fax number for medication prior authorizations will remain:
1-844-205-3386.

If you have additional questions, you can reach out to PHW member services at 1-844-626-6813.

Table of Contents

Each link will take you directly to that section for easy to find information.

Electronic Prior Authorization SubmissionsGeneral PA Forms
Medicaid CHC Medication Specific PA FormsPharmacy Policies
Preferred Drug List (PDL) PHW Supplemental Drug List
PHW Specialty Medication ListPHW Quantity Limit
Filling Prescriptions for Extended Day SupplyExpress Scripts Pharmacy Network
DEA National Take Back Prescription Drug ProgramPharmacy and Therapeutics Committee Meeting Minutes 

From PA Health and Wellness

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

This Pennsylvania prescription drug coverage 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.

Electronic Prior Authorization Submissions

Submit your prior authorization (PA) requests electronically through CoverMyMeds.

Electronic prior authorization (ePA) automates the PA process making it a simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations. 

For select drugs and plans, CoverMyMeds may issue immediate approval of your request and updtae your patient PA record to allow immediate claim adjudication.

General PA Forms

Medicaid CHC Medication Specific PA Forms

Below, please find medication specific prior authorization forms that align with our approved prior authorization policies.

Pharmacy Policies

To access, view or download an active Pharmacy Policy for a covered drug on the Pennsylvania Medical Assistance Program's Statewide Preferred Drug List (PDF) or the PHW Supplemental Drug List, visit the following:

PA Health and Wellness Policies

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:

Pennsylvania Medical Assistance Program's Statewide Preferred Drug List (PDL)

PHW Supplemental Drug List

Download the PHW Supplemental Drug List (PDF)

PHW Specialty Medication List

Download the PHW Specialty Medication List (PDF)

PHW Quantity Limit

Download the List PHW Quantity Limit List (PDF)

Filling Prescriptions for Extended Day Supply

PA Health and Wellness members may fill prescriptions for certain maintenance medications for up to a 90 day supply at participating pharmacies. To see which medications are eligible to be filled for extended day supply and which pharmacies participate in the extended day supply program, click the links below or contact a customer service representative at 1-844-626-6813 (TTY 711):

Express Scripts Pharmacy Network (For use in 2024)

To view the list of Express Scripts Network Pharmacies contracted with PA Health and Wellness in 2024, download the Contracted Express Scripts Network Pharmacies (PDF)

DEA National Take Back Prescription Drug Program

Learn more about the DEA National Take Back program, and find an authorized collector in your area with the DEA National Take Back Prescription Online Resource.

Pharmacy and Therapeutics Suggestions

Download the Pharmacy and Therapeutics Suggestion Form (PDF)

Pharmacy and Therapeutics Committee Meeting Minutes 

2024

2023

2022

2021

2020

2019

2018