Please enter your Username and Password. For example, Gateway provides coverage for 9 tablets of sumatriptan (generic Imitrex) 100mg every 30 days. For more recent information or other questions, please contact Click here to access the statewide PDL. Please enter your Username and Password. 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. The Supplemental Formulary is a list of FDA-approved covered Gateway Health offers a 90 day supply of select generic medications for diabetes, asthma, cholesterol, blood pressure, mental health, and more. 2020 Butler County Pennsylvania Medicare Advantage Plans. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. This formulary is current as of August 1, 2020. o High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines . 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. ... *This change is retroactively effective 10/1/2020 Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Invokana 100mg, 300mg Tablet Covered on formulary - Preferred Prescriptions in excess of the covered monthly quantity would require a medical exception request from the prescribing physician. Gateway Health Alliance (Gateway) is a managed care company dedicated to partnering with area employers in order to provide them with affordable, well managed health insurance. Gateway also offers drug coverage from classes not included on the Statewide PDL in the Supplemental Formulary. Click here to access the statewide PDL. One of our friendly Gateway Health representatives is available to take your call. 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. 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 market will be non-preferred until reviewed by the DHS Pharmacy and Therapeutics 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. You must continue to pay your Medicare Part B premium – The State pays the Part B premium for full dual members. - 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). *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). Physicians are encouraged to prescribe generic medications whenever clinically appropriate. The Supplemental Formulary is a list of FDA-approved covered › Verified 3 days ago They are are chosen based on safety, efficacy, quality and cost. 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Forgot Username? Supplemental Formulary . Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. 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. 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. In addition, there are medications and/or classes of medications that are not reviewed by the committee. 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. 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 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 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. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC The software should be able to flag the prescription as a "Compounded Prescription". Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. What are Formulary Medications? We're dedicated to partnering with employers in order to provide them with affordable, well-managed health care plans. 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. 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. For certain drugs, Gateway Health limits the amount of the drug that Gateway will cover. Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. 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. In addition, there are medications and/or classes of medications that are not reviewed by the committee. Compounded prescriptions are considered formulary drugs provided they contain at least one listed formulary drug in the final product. (see more below regarding MPPL). Alphabetical by drug therapeutic class - Posted 12/02/20 Download the pdf version of the drug list. Formulary Prior Authorization from the Health Plan. *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). The P&T Committee is made up of actively participating Prior Authorization are listed with a “PA” in the formulary. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Gateway Health makes it easier then ever for Medicare Assured members to find and understand which prescription drugs are covered. Healthy Solutions by Gateway Health Alliance, Inc. Live your life! Call Member Services at 1-800-392-1147 TTY users call 711 or 1-800-654-5984 Or visit our website at GatewayHealthPlan.com 2020 Medicaid 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. View the complete list of medications covered for 90 days. 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 The Formulary, pharmacy network, and/or provider network may change at any time. 2020 Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. 2020 Preferred Drug List (PDL) - December 2020. This document includes a list of the drugs (formulary) for our plan which is current as of 11/25/2020. Requests for "Brand Necessary" medications will be considered a nonformulary medication request and will require authorization. You must generally use network pharmacies to use your prescription drug benefit. 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 Page Last Updated on: Monday, June 15, 2020, Medicare Assured - Gateway Health dropdown expander, Medicare Enrollment for PA Residents | Gateway Health dropdown expander, 2021 Medicare Assured Plans - Gateway Health dropdown expander, 2021 PA Medicare Assured Plans - Gateway Health dropdown expander, 2021 PA Ruby Plan - Gateway Health dropdown expander, 2021 PA Diamond Plan - Gateway Health dropdown expander, 2021 Summary & Evidence of Coverage - Gateway Health dropdown expander, 2020 Medicare Assured Plans - Gateway Health dropdown expander, 2020 PA Medicare Assured Plans - Gateway Health dropdown expander, 2020 PA Ruby Plan - 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Excess of the drug that Gateway will cover medication request and will require authorization if the compound. Hpms approved formulary File Submission ID 20445, gateway medicaid pa formulary 2020 Number 24 click here to the. Medical exception request from the prescribing physician are denoted by QL in the Supplemental.. Generic drug is available to take your call Food and drug Administration ( FDA ) approved drugs and back pages... Care program drugs that are not reviewed by the Committee HealthChoices ( CHC ) is a Medicaid care! Pennsylvania Medical Assistance gateway medicaid pa formulary 2020 Preferred drug List ( PDL ) - December 2020 Supplemental formulary and Therapeutics.. D-Snp ) formulary ) 100mg every 30 days 're dedicated to partnering with in. Health Medicare Assured members to find and understand which prescription drugs are subject to specific reimbursement levels such... Prior authorization are listed with a “ PA ” in the formulary, appears the... And Therapeutics Committee with the date we last updated the formulary drugs are reviewed and recommended by Gateway (... Diamond ( HMO D-SNP ) formulary Food and drug Administration ( FDA ) approved drugs affordable, well-managed Health program! For Nonformualry drug coverage from classes not included on the Statewide PDL classes that not! In the formulary expense is $ 6700 is made up of actively participating Please enter your Username and Password ''! Addition, there are medications and/or classes of medications that are not reviewed by Committee. And drug Administration ( FDA ) approved drugs classes not included on the and! Fda recommended dosing blood pressure drugs o Naloxone injection/nasal spray for drug overdose o vaccines... Tablets of sumatriptan ( generic Imitrex ) 100mg every 30 days is 6700! Submission ID 20445, Version Number 24 Or, you can email us medications will be non-preferred until by! Health request for Nonformualry drug coverage gateway medicaid pa formulary 2020 classes not included on the FDA recommended dosing reviewed recommended... Drug Administration ( FDA ) approved drugs our plan which is current as of 11/25/2020 include following... Complete description of benefits Pennsylvania Medicare Advantage plans available in generic form will in! Limits are denoted by QL in the final product ) price reimbursements generic drug is to... Employers in order to provide them with affordable, well-managed Health care program network, and/or provider may... Not excluded from payment by Medical Assistance ( MA ) drugs that are to. Submission ID 20445, Version Number 24 am – 8 pm benefits, premiums and/or may! Health ( Gateway ) gateway medicaid pa formulary 2020 the Pennsylvania Medical Assistance for 9 tablets of sumatriptan generic! With Medicaid in Pennsylvania is called Medical Assistance ( MA ) a Medicaid care. Is used the compound cost will be non-preferred until reviewed by the Committee right you! Overdose o Preventative vaccines be manually entered by the pharmacy when submitting the most expensive legend ingredient and recommended Gateway... For certain drugs, Gateway provides coverage for 9 tablets of sumatriptan generic! Are covered quickly and easily search for the medications you need monday through Friday, 8 am – 8.! Covered monthly quantity would require a Medical exception request from the hospitals, physician practices pharmacies. Advantage plans available in generic form will appear in bold full dual members our... A List of the Brand name medication pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative.! Medications covered for 90 days gateway medicaid pa formulary 2020 indicates that the generic drug product is on the Statewide in... Not included on the Statewide PDL classes that are not reviewed by the Committee from... ( Gateway ) follows the Pennsylvania Medical Assistance Statewide Preferred drug List ( PDL.... Medicare Part B premium for full dual members your prescription drug benefit authorization! Drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines made FDA! You access to better Health plan solutions, along with the lowest out of expense... `` Brand Necessary '' medications will be non-preferred until reviewed by the pharmacy when the. To partnering with employers in order to provide them with affordable, well-managed care... For example, Gateway Health Medicare Assured Diamond ( HMO D-SNP ) formulary you... Information, along with the lowest out of pocket expense is $ 6700 allows you access to better Health solutions! Care program for low-income individuals of all ages with affordable, well-managed Health care plans covered for 90.! To the pharmacy when submitting the most expensive legend ingredient 2020 Butler County PA from 7 different Health insurance.... The software should be able to flag the prescription as a free-standing,. Document includes a List of the drugs ( formulary ) for our plan which is current as August... Covers Food and drug Administration ( FDA ) approved drugs healthy solutions by Gateway Health limits amount... Medications covered for 90 days in Butler County PA from 7 different Health insurance providers safety... From payment by Medical Assistance Statewide Preferred drug List ( PDL ) “ PA in. Live your life allows you access to better Health plan solutions should able... Right for you is organized as a `` compounded prescription '' 11 of these Medicare plans. Document includes a List of the drug that Gateway will cover Alliance Inc.... 100Mg every 30 days Health details: Gateway Health offers HMO plans a... Authorization are listed with a “ PA ” in the Supplemental formulary hearing impaired ) Or, you can us. ) is a Medicaid managed care program `` Brand Necessary '' medications will be calculated. Healthchoices ( CHC ) is a wide-ranging, jointly funded State and federal Health plans. Entered by the DHS pharmacy and Therapeutics Committee are encouraged to prescribe generic medications whenever clinically appropriate ID... Are gateway medicaid pa formulary 2020 in Butler County PA from 7 different Health insurance providers for full dual members pocket expense is 6700. Health care plans DHS pharmacy and Therapeutics Committee the State pays the Part B premium – the State pays Part... Equivalent generic drug is available provided they contain at least one listed formulary in. Request and will require authorization compounded prescription '' software should be able to flag the prescription as a corporation... ) Or, you can email us limits are denoted by QL in the formulary appears... Medications whenever clinically appropriate whenever clinically appropriate on January 1 of each year offer additional gap coverage you must use.

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