Medicaid Medication Policies

*Statewide Preferred Drug List (PDL) Effective January 1, 2020*

As of January 1, 2020, all managed care organizations (MCOs) that provide outpatient drug services to Medicaid beneficiaries in Pennsylvania and the State Fee-for-Service (FFS) program will use the same Preferred Drug List (PDL). Any drugs designated as non-preferred will require prior authorization. In addition, the PA Medicaid MCOs and the FFS program will apply the same clinical prior authorization criteria to determine medical necessity for medications included on the PDL.  You may access the complete statewide PDL now through the Department of Human Services website. Beginning January 1, the searchable PDL and prior authorization guidelines will also be located on the Gateway Health, Medicaid website.

**Please note that all requirements and conditions governing coverage of outpatient drugs, including but not limited to prior authorization criteria, apply whether a drug is provided through the Pharmacy benefit or Medical benefit.