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Prior Authorization
Drug Utilization Considerations for Primary Care Providers
Prior Authorization of Drugs
Prior authorization is required for those services and items so designated in the MA Program Fee Schedule with the prior authorization (PA) indicator as well as any drug class for which a Medical Assistance Bulletin has been posted.
DPW requires prior authorization on certain drugs. Pharmacy claims will be rejected unless the Provider receives prior authorization from DPW and the pharmacist uses the prior authorization number to bill DPW.
Initiating the Prior Authorization Request
The prescribing provider must request the prior authorization. Please note that if the requesting prescribing provider is a Certified Registered Nurse Practitioner or a Physician’s Assistant, the requested drug prescribed must be one the practitioner is licensed to prescribe in Pennsylvania. Otherwise, a supervising or referred physician must request the prior authorization.
- Call the Prior Authorization Unit at 1-800-558-4477 (this telephone number is reserved for prescribing providers only)
- The MA Fee-for-Service Program Prior Authorization Unit accepts requests for prior authorization between 8:00 AM and 4:30 PM, Monday through Friday
Additional information regarding the prior authorization of drugs can be found in the MA bulletins. Click here to search bulletins on the DPW website. Type “prior authorization” in the key word search feature to read more.
For general pharmacy prior authorization requirements from DPW, please click here.