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Pharmacy Services
The Medical Assistance (MA) Program’s Fee-for-Service (FSS) delivery system provides coverage of a comprehensive array of medications for clients whose healthcare benefit packages include pharmacy services. The scope of covered services includes certain brand name, generic, as well as certain over the counter (OTC) drugs, certain vitamins, insulin and diabetic supplies, and vaccines.
Expand the topics below to provide more information about pharmacy services in FFS:
Covered Drugs To determine if a drug is covered, the requirements for coverage and payment information, click on Covered Drugs and enter either the name of the drug, or the National Drug Code (NDC), or the class of drugs.
The Specialty Drug Program The MA Specialty Drug Program selectively contracts with two nationally recognized specialty pharmacies to provide:
- A reliable and convenient dispensing and delivery system for providers and FFS clients that facilitates care in clinically appropriate settings.
- A clinical support system designed to optimize therapy management, care coordination, and patient compliance.
For more information the specialty drug program click here. Click here to view a map of MA clients impacted by the specialty pharmacy drug program.
Preferred Drug List (PDL) FFS has a Preferred Drug List which is a list of drugs that a committee of medical experts, including physicians and pharmacists, determined to be best in class based upon clinical effectiveness, safety, and healthcare outcomes. The MA Program contracts with Provider Synergies, LLC to provide consultation and support in administering the Preferred Drug List. To view the Preferred Drug List visit Provider Synergies, LLC and click on Pennsylvania PDF under useful links. To view the guidelines used to determine medical necessity of a drug that requires prior authorization, click on the name of the class of drugs.
For more information on the PDL, click here.
Drug Utilization Review (DUR) Board The DUR Board recommends the application of predetermined standards related to Prospective DUR (ProDUR), Retrospective DUR (RetroDUR), and related administrative and educational interventions designed to protect the health and safety of MA Program clients.
Pharmacy and Therapeutics (P&T) Committee The P&T Committee serves as an advisory board to the MA Program and recommends a Preferred Drug List (PDL) that promotes the use of safe and effective Food and Drug Administration (FDA) - approved medications. The Committee ensures that the pharmacy utilization management is based on sound clinical evidence that is both safe and cost-effective.