Skip to Main Content

Conduent Business Solutions, one of our vendors, experienced a cybersecurity issue on January 13, 2025. To learn more, view Conduent's notice  or reach out to their contact center at 1-855-720-3675.

Pharmacy Services

Express Scripts Billing Information

Please note the following billing information for our Community HealthChoices Plan (CHC) and Children’s Health Insurance Plan (CHIP):

Community HealthChoices (CHC)

BIN: 003858
PCN: MA
GRP: 2FBA

Children's Health Insurance Program (CHIP)

BIN: 003858
PCN: MACP
GRP: 2FBA

For claims related issues, the Express Scripts Pharmacy Help Desk can be reached at:

CHC: 1-833-750-4504

CHIP: 1-833-750-9898 

Table of Contents

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

From PA Health and Wellness

Ensuring Access to Safe and Effective Medications: At PA Health and Wellness, we are committed to providing appropriate, high-quality, and cost-effective drug therapy to all PA Health and Wellness members. With our partners, we provide innovative and tailored pharmacy solutions, improving member health outcomes by ensuring access to essential medications, cost effective treatments and personalized clinical programs.

PHW Pharmacist Provider Status

Per Medical Assistance Bulletin MAB2024021301, the state now allows Pharmacists to enroll as Mid-Level Practitioners to complete various lab testing, smoking and tobacco cessation counselling, vaccine administration, injections, MTM, and evaluation and management of patients. Please check the state’s latest bulletin on Pharmacist Provider Status to see a list of eligible services that pharmacists can provide and bill for. The guide below provides instructions on how you can get enrolled as a Pharmacist Provider with PHW.

PHW Pharmacist Provider Status How To Guide (PDF)

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.

A

B

C

D

E

G

H

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

Formularies

CHC

The Preferred Drug List (PDL) is the list of drugs covered by PA Health and Wellness. PA Health and Wellness asks that doctors prescribe medications from the PA Health and Wellness preferred drug list for their patients. Some drugs will a prior approval request before the medication can be given to the member at the pharmacy. These drugs are on the prior approval list.

WellKids by PA Health and Wellness

WellKids by PA Health and Wellness utilizes a CHIP Formulary which includes a list of drugs covered by the plan. PA Health and Wellness asks that doctors prescribe medications from the CHIP Formulary for their patients. Some drugs will a prior approval request before the medication can be given to the member at the pharmacy. These drugs are on the prior approval list.

Drug Look-Up Tool

Search the list of FDA-approved drugs and coverage by clicking the button below.

CHC:  Medicaid Formulary Search

CHIP: CHIP Formulary Search

Formulary Changes

PHW Oncology Split Fill Program List

Download the PHW Oncology Split Fill Program 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 

To view the list of Express Scripts Network Pharmacies contracted with PA Health and Wellness in 2026, 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 

2025

2024

2023

2022

2021

2020

2019

2018