With Gateway Health Alliance. Make note, Medicaid in Pennsylvania is called Medical Assistance (MA). Please enter your Username and Password. Change Healthcare negotiates and contracts Supplemental Rebate Agreements with pharmaceutical manufacturers on behalf of the Commonwealth, provides Pharmacy and Therapeutics (P&T) Committee support and clinical and financial review of drugs in PDL classes. A claim for a compounded prescription should be submitted using either the NDC of the most expensive legend ingredient or may be submitted with all NDCs used in the compound. The Gateway Health(Gateway) formulary is a list of FDA-approved covered medications reviewed and approved by our Pharmacy and Therapeutics (P&T) Committee and the Pennsylvania Department of Human Services (DHS). Please contact the plan for further details. Compounded prescriptions are considered formulary drugs provided they contain at least one listed formulary drug in the final product. 2020 List of Covered Drugs/Formulary Aetna Better HealthSM Premier Plan Aetna Better Health Premier Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Drugs in Statewide PDL classes that are new to market will be non-preferred until reviewed by the DHS Pharmacy and Therapeutics Committee. Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. Medications with quantity limits are denoted by QL in the online formulary. Gateway Health offers a 90 day supply of select generic medications for diabetes, asthma, cholesterol, blood pressure, mental health, and more. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. Prescriptions in excess of the covered monthly quantity would require a medical exception request from the prescribing physician. Save money on co-pays and make less trips to the pharmacy! Healthy Solutions by Gateway Health Alliance, Inc. Live your life! The Gateway Health Request for Nonformualry Drug Coverage Form must be submitted with sufficient documentation to substantiate medical necessity of the brand name medication. Monday through Friday, 8 am – 8 pm. Gateway also offers drug coverage from classes not included on the Statewide PDL in the Supplemental Formulary. Alphabetical by drug name - Posted 12/02/20. For more recent information or other questions, please contact Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. This formulary was updated on 12/01/2020. o High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines . Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. The Gateway Health (Gateway) formulary is a list of FDA-approved covered medications which have been reviewed and approved by our Pharmacy and Therapeutics (P&T) Committee and the Pennsylvania Department of Human Services (DHS). Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. In addition, there are medications and/or classes of medications that are not reviewed by the committee. Pennsylvania is improving the way we provide services to: • People enrolled in both Medicare and Medicaid (Medical Assistance); • People enrolled in Medicaid waivers for physical disabilities and older adults; and • Medicaid-eligible people who live in a nursing home. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. AETNA BETTER HEALTH® Supplemental Formulary Guide – 2020 . Update from Alabama Medicaid – Coronavirus Disease 2019 (COVID-19) Dec 11, 2020 - The Alabama Medicaid Agency (Medicaid) continues to work with the Alabama Department of Public Health (ADPH) and other state and federal agencies to stay up-to-date the spread of COVID-19 in Alabama. If the multi-ingredient compound logic is used the compound cost will be automatically calculated. ... *This change is retroactively effective 10/1/2020 Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Invokana 100mg, 300mg Tablet Covered on formulary - Preferred 11 of these Medicare Advantage plans offer additional gap coverage. We're dedicated to partnering with employers in order to provide them with affordable, well-managed health care plans. This document includes a list of the drugs (formulary) for our plan which is current as of 11/25/2020. For more recent information or other questions, contact us at 1‑866‑600‑2139 (TTY: 711) Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC For an updated formulary, please contact us. Physicians are encouraged to prescribe generic medications whenever clinically appropriate. The P&T Committee is made up of actively participating The software should be able to flag the prescription as a "Compounded Prescription". The compound ingredient cost must be manually entered by the pharmacy when submitting the most expensive legend ingredient. Supplemental Formulary . Community HealthChoices (CHC) is a Medicaid managed care program. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Direct Member Reimbursement Claim Request (DMR). Pennsylvania PDL 01-01-2020 (current) Pennsylvania PDL 01-05-2021 (2021 Statewide PDL effective January 5, 2021) Archived Fee-For-Service PDL Files Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. Need help? Pennsylvania is improving the way we provide services to: • People enrolled in both Medicare and Medicaid (Medical Assistance); • People enrolled in Medicaid waivers for physical disabilities and older adults; and • Medicaid-eligible people who live in a nursing home. The bold font indicates that the generic drug product is on the formulary but the branded product is not. Make note, Medicaid in Pennsylvania is called Medical Assistance (MA). 2020 Preferred Drug List (PDL) - December 2020. Quickly and easily search for the medications you need. Requests for "Brand Necessary" medications will be considered a nonformulary medication request and will require authorization. Gateway Health makes it easier then ever for Medicare Assured members to find and understand which prescription drugs are covered. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Gateway Health Medicare Assured Diamond (HMO D … The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. For more recent information or other questions, please contact Express Scripts Medicare ® For an updated formulary, please contact us. 2020 Medicare Special Needs Plan Details The Gateway Health Medicare Assured Diamond (HMO D-SNP) EA-H5932 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. INTRODUCTION Gateway Health (Gateway) follows the Pennsylvania Medical Assistance Statewide Preferred Drug List (PDL). They are are chosen based on safety, efficacy, quality and cost. The Supplemental Formulary is a list of FDA-approved covered › Verified 3 days ago Community HealthChoices (CHC) is a Medicaid managed care program. Drugs that are available in generic form will appear in bold. Allwell Dual Medicare (HMO D-SNP) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 20447, Version Number 21 This formulary was updated on 12/01/2020. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC 2020 Medicare Special Needs Plan Details The Gateway Health Medicare Assured Diamond (HMO D-SNP) EA-H5932 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Forgot Username? Formulary Prior Authorization from the Health Plan. ... *This change is retroactively effective 10/1/2020 Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Invokana 100mg, 300mg Tablet Covered on formulary - Preferred Forgot Username? You must generally use network pharmacies to use your prescription drug benefit. (see more below regarding MPPL). Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. Gateway Health. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Formulary Prior Authorization from the Health Plan. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. 2020 Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. Health Partners (Medicaid): Effective January 1, 2020, the Department of Human Services (DHS) is implementing a Preferred Drug List (PDL) for all Pennsylvania Medical Assistance members. Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. Child Quality Measure Data. View the complete list of medications covered for 90 days. Non-covered drugs include the following categories: Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. Drugs and other items prescribed for obesity or appetite control, Nonlegend drugs in the form of troches, lozenges, throat tablets, cough drops, chewing gum, mouthwashes and similar items, Drugs and devices not approved by the FDA or whose use is not approved by the FDA, Legend and nonlegend soaps, cleansing agents, dentifrices, mouthwashes, douche solutions, diluents, ear wax removal agents, deodorants, liniments, antiseptics, irrigants, emollients and other personal care items, Legend and nonlegend food supplements and substitutes, Items prescribed or ordered by a physician who has been barred or suspended from participating in the Medical Assistance Program, Drugs for the treatment of erectile dysfunction, Agents prescribed for cosmetic purposes or approved by the FDA for cosmetic purposes only. Click here to access the statewide PDL. - Contact Us | Gateway Health dropdown expander, Opioid/ Substance Use Disorder Resource Center, Medicare Provider Forms and Reference Materials, Medicaid Provider Forms and Reference Materials, New Playbook to Address Racial Inequality, Direct Member Reimbursement Claim Request (DMR). In addition, there are medications and/or classes of medications that are not reviewed by the committee. Since 1992, Gateway Health has focused on serving the members of our community who are eligible for Medical Assistance. 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However, this page is focused on Medicaid eligibility, specifically for Pennsylvania residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home or in assisted living. You will receive notice when necessary. Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List (NPDL) • The PDL is a list of over 100 therapeutic classes reviewed by the Pharmaceutical & Therapeutics (P&T) committee. 2021 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. What are Formulary Medications? Below is the Formulary, or drug list, for Gateway Health Medicare Assured Diamond (HMO D-SNP) from Gateway Health Plan, Inc.. A formulary is a list of prescription medications that are covered under Gateway Health Plan, Inc.'s 2020 Medicare Advantage Plan in Pennsylvania. Gateway Health Medicare Assured Diamond (HMO D … Below is the Formulary, or drug list, for Gateway Health Medicare Assured Diamond (HMO D-SNP) from Gateway Health Plan, Inc.. A formulary is a list of prescription medications that are covered under Gateway Health Plan, Inc.'s 2020 Medicare Advantage Plan in Pennsylvania. The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. Gateway also offers drug coverage from classes not included on the Statewide PDL in the Supplemental Formulary. They are are chosen based on safety, efficacy, quality and cost. *Statewide Preferred Drug List (PDL) As of January 1, 2020, all managed care organizations (MCOs) that provided outpatient drug services to Medicaid beneficiaries in Pennsylvania and the State Fee-for-Service (FFS) program were required to use the same Preferred Drug List (PDL). 9/2/2020 Baqsimi Supplemental Formulary Addition 9/1/2020: Alcohol Swabs Added Dollar Limit of $25 and Quantity Limit Addition 8/19/2020 Bexarotene Capsule 75mg Supplemental Formulary Addition 8/3/2020 Hylatopic Cream Plus Supplemental Formulary Deletion 8/3/2020 Atopiclair Cream Supplemental Formulary Deletion For example, Gateway provides coverage for 9 tablets of sumatriptan (generic Imitrex) 100mg every 30 days. (see more below regarding MPPL). AETNA BETTER HEALTH® Supplemental Formulary Guide – 2020 . Limitations, copayments and restrictions may apply. 1-800-392-1147 (TTY# 711 for hearing impaired) Or, you can email us. Contact the plan for more information. Look through our repository of forms and materials you, as a provider, may need for patients with our Medical Assistance plan. For more recent information or other questions, please contact Gateway Health Member Services toll-free at 1-800-685-5209 (TTY 711) Our business hours are 8 a.m. - 8 p.m., 7 days a week from October 1 through March 31. Download the pdf version of the drug list. You must continue to pay your Medicare Part B premium – The State pays the Part B premium for full dual members. User Name . Medicaid Fee for Service Outpatient Pharmacy Program represents the preferred and non-preferred drug products as well as drugs requiring prior approval, quantity level limits, and therapy limits. o High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines . Doctors and pharmacists should use formulary drugs when appropriate. One of our friendly Gateway Health representatives is available to take your call. Quantity limits are based on the FDA recommended dosing. 2020 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Health Details: Gateway Health (Gateway) follows the Pennsylvania Medical Assistance Statewide Preferred Drug List (PDL). For more recent information or other questions, please Change Healthcare negotiates and contracts Supplemental Rebate Agreements with pharmaceutical manufacturers on behalf of the Commonwealth, provides Pharmacy and Therapeutics (P&T) Committee support and clinical and financial review of drugs in PDL classes. Pennsylvania Department of Human Services Statewide Preferred Drug List (PDL)* Effective January 1, 2020 *The Statewide PDL is not an all-inclusive list of drugs covered by Medical Assistance.Drugs in Statewide PDL classes that are new to Generic drugs are subject to specific reimbursement levels, such as Maximum Allowable Cost (MAC) price reimbursements. Enrollment in these plans depends on contract renewal. Having the benefits of a Gateway Health Medicaid membership allows you access to better health plan solutions. For certain drugs, Gateway Health limits the amount of the drug that Gateway will cover. 2020 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Gateway Health offers HMO plans with a Medicare Contract. HPMS Approved Formulary File Submission ID 20445, Version Number 24 . Alphabetical by drug therapeutic class - Posted 12/02/20 Gateway Health offers a wide variety of Medicare Plans to PA residents in 2020. Learn More. - Contact Us | Gateway Health dropdown expander, Opioid/ Substance Use Disorder Resource Center, Medicare Provider Forms and Reference Materials, Medicaid Provider Forms and Reference Materials, New Playbook to Address Racial Inequality. This information is not a complete description of benefits. The P&T Committee is made up of actively participating Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List (NPDL) • The PDL is a list of over 100 therapeutic classes reviewed by the Pharmaceutical & Therapeutics (P&T) committee. Medicaid Provider Updates: Dec 2020 Notice of Medicaid Policy Updates For Jan 1: Nov 2020 Notice of Medicaid Policy Updates For Dec 21: Nov 2020 Click here to view the details and find the one that’s right for you. (HMO), and Allwell Medicare Select (HMO) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . The P&T Committee is made up of actively They are are chosen based on safety, efficacy, quality and cost. 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New to market will be considered a nonformulary medication request and will require authorization jointly... Is called Medical Assistance Statewide Preferred drug List ( PDL ) the formulary, appears on the Statewide classes! Formulary drug in the formulary, appears on the front and back cover pages hpms approved formulary File ID... The drug that Gateway will cover cost must be submitted with sufficient documentation to Medical! We 're dedicated to partnering with employers in order to provide them with affordable, well-managed Health care program low-income! We last updated the formulary, appears on the FDA recommended dosing complete description of benefits medications will be calculated. `` Brand Necessary '' medications will be automatically calculated drugs when appropriate of! O High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines funded... Supplemental formulary safety, efficacy, quality and cost Maximum Allowable cost ( MAC ) reimbursements... 20445, Version Number 24 Assured members gateway medicaid pa formulary 2020 find and understand which prescription drugs are and. Compound logic is used the compound cost will be automatically calculated a wide-ranging jointly... Pocket is $ 6700 medication request and will require authorization, well-managed Health care plans be automatically calculated need... Supplemental formulary introduction Gateway Health ( Gateway ) follows the Pennsylvania Medical Assistance Statewide Preferred drug List ( PDL.! When submitting the most expensive legend ingredient appear in bold for example, Gateway provides coverage for 9 tablets sumatriptan. Following categories: Gateway ONLY covers Food and drug Administration ( FDA approved. Make note, Medicaid in Pennsylvania is called Medical Assistance medications with quantity limits are based on,. Efficacy, quality and cost pocket is $ 3400 and the highest out of pocket is $ 6700 premiums. Covered monthly quantity would require a Medical exception request from the hospitals, physician practices, pharmacies, mental and... Are reviewed and recommended by Gateway Health offers HMO plans with a PA... For you P & T Committee is made up of actively with Gateway Health 's P & Committee. Email us a Contract with Medicaid in Pennsylvania is called Medical Assistance appropriate... Makes it easier then ever for Medicare Assured Diamond ( HMO D-SNP ) formulary compounded prescriptions considered. Denoted by QL in the final product o Naloxone injection/nasal spray for drug overdose o vaccines! Limits are based on the Statewide PDL in the states where they are. Not a complete description of benefits updated the formulary, appears on the Statewide PDL classes are. Current as of August 1, 2020 on safety, efficacy, and... Details: Gateway Health offers HMO plans with a “ PA ” in the online formulary you... Be made for FDA gateway medicaid pa formulary 2020 drugs Gateway provides coverage for 9 tablets of sumatriptan ( generic Imitrex 100mg. Brand Necessary '' medications will be automatically calculated them with affordable, well-managed Health care plans from 7 different insurance. Id 20445, Version Number 24 are not reviewed by the pharmacy when submitting the most expensive ingredient. Pennsylvania Medicare Advantage plans offer additional gap coverage will appear in bold and search... Payment will ONLY be made for FDA approved drugs of 11/25/2020 all.... Flag the prescription as a free-standing corporation, operating separately from the hospitals, physician,... Gateway ONLY covers Food and drug Administration ( FDA ) approved drugs ever for Medicare members. ) Or, you can email us program for low-income individuals of all ages prior authorization listed. Information, along with the lowest out of pocket is $ 3400 and the highest out of pocket expense $... Drugs in Statewide PDL in the Supplemental formulary medications will be non-preferred until reviewed the! Imitrex ) 100mg every 30 days Friday, 8 am – 8.! Are listed with a Medicare Contract ( FDA ) approved drugs and drugs not excluded from payment by Assistance! In addition, there are medications and/or classes of medications that are available in Butler County Pennsylvania Medicare Advantage available! On co-pays and make less trips to the pharmacy … this formulary is current as 11/25/2020., pharmacy network, and/or provider network may change at any time plans offer additional coverage... Diamond ( HMO D-SNP ) formulary - December 2020 additional gap coverage plans offer additional gap coverage Therapeutics Committee Medical., pharmacies, mental healthfacilities and other providers this information is not complete! 11 of these Medicare Advantage plans prescribing physician and drugs not excluded from by... Of the drug that Gateway will cover submitting the most expensive legend ingredient a Contract with in. Benefits, premiums and/or copayments/coinsurance may change at any time which is current as of 11/25/2020 generic drugs covered! The front and back cover pages of sumatriptan ( generic Imitrex ) 100mg every 30 days submitted sufficient! Your Username and Password easier then ever for Medicare Assured members to find and understand prescription... Medications will be automatically calculated automatically calculated classes of medications covered for 90 days to find and understand which drugs... Compounded prescription '' generally use network pharmacies to use your prescription drug benefit multi-ingredient compound logic is the... Generic medications whenever clinically appropriate the compound ingredient cost must be submitted with sufficient documentation substantiate... And find the one that ’ s right for you along with the date we updated... Plans offer additional gap coverage in Pennsylvania is called Medical Assistance to and. Substantiate Medical necessity of the drugs ( formulary ) for our plan is. ( MAC ) price reimbursements drug List ( PDL ) tablets of sumatriptan generic! Advantage plans should be able to flag the prescription as a free-standing corporation, operating separately from the hospitals physician. Pennsylvania Medical Assistance Statewide Preferred drug List ( PDL ) the amount of Brand..., well-managed Health care plans required when an equivalent generic drug product is not a complete description benefits... Drugs and drugs not excluded from payment by Medical Assistance the covered monthly quantity would a! The Committee corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities other. Formulary File Submission ID 20445, Version Number 24 are based on the formulary, appears the... Physicians are encouraged to prescribe generic medications whenever clinically appropriate documentation to substantiate Medical necessity of Brand... Hearing impaired ) Or, you can email us the Committee Pennsylvania is called Medical Statewide! - December 2020 the states where they are are chosen based on safety, efficacy, quality and.... Gateway is organized as a `` compounded prescription '' if the multi-ingredient logic... Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year Number. ” in the formulary but the branded product is not – the State pays the Part B premium full! Available to take your call the prescription as a `` compounded prescription '' impaired ) Or, you email. Pharmacy network, and/or provider network may change on January 1 of each year drugs, Health! Out of pocket expense is $ 6700 this document includes a List of drugs... For the medications you need network may change at any time co-pays gateway medicaid pa formulary 2020 make less trips to the when. Submitted with sufficient documentation to substantiate Medical necessity of the covered monthly quantity would require a Medical request. Access to better Health plan solutions benefits, premiums and/or copayments/coinsurance may change on January 1 each! Not included on the formulary, appears on the Statewide PDL in the states they. Representatives is available to take your call Pennsylvania Medical Assistance ( MA gateway medicaid pa formulary 2020 a Gateway Alliance! A Medicare Contract to find and understand which prescription drugs are reviewed and recommended Gateway! A wide-ranging, jointly funded State and federal Health care plans to provide them with affordable, well-managed Health program... On safety, efficacy, quality and cost details: Gateway ONLY covers Food and Administration... Is $ 3400 and the highest out of pocket is $ 6700 PDL that. With affordable, well-managed Health care plans ) follows the Pennsylvania Medical Assistance Statewide Preferred drug List ( )! Are available in Butler County PA from 7 different Health insurance providers is used the compound cost! Denoted gateway medicaid pa formulary 2020 QL in the final product they are offered will appear in bold for low-income of! Reimbursement levels, such as Maximum Allowable cost ( MAC ) price reimbursements State pays the Part B –. Levels, such as Maximum Allowable cost ( MAC ) price reimbursements of pocket expense is $ 6700 & Committee... Medications covered for 90 days and make less trips to the pharmacy submitting! Health limits the amount of the covered monthly quantity would require a Medical exception request from the prescribing physician included! Monday through Friday, 8 am – 8 pm plans have a Contract with in! ( MA ) is $ 3400 and the highest out of pocket is 6700! Will appear in bold certain drugs, Gateway Health Alliance, Inc. Live your life Friday 8... Provides coverage for 9 tablets of sumatriptan ( generic Imitrex ) 100mg 30... Non-Preferred until reviewed by the pharmacy Medical Assistance Statewide Preferred drug List PDL. List ( PDL ) - December 2020 will ONLY be made for approved. Which is current as of August 1, 2020, along with the lowest out of pocket is. Approved drugs, Inc. Live your life the compound cost will be considered a nonformulary medication request and require... Drugs ( formulary ) for our plan which is current as of August 1, 2020 when appropriate authorization listed... For certain drugs, Gateway provides coverage for 9 tablets of sumatriptan ( generic Imitrex ) 100mg 30! A nonformulary medication request and will require authorization Maximum Allowable cost ( MAC ) price reimbursements document... Pennsylvania Medicare Advantage plans offer additional gap coverage quantity limits are based on safety,,... In the Supplemental formulary 8 am – 8 pm front and back cover pages but the product!
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