Pharmacy Services | Department of Human Services | Commonwealth of Pennsylvania

Pharmacy Services | Department of Human Services | Commonwealth of Pennsylvania
Pharmacy Services
The Pharmacy Services program of the Department of Human Services (DHS) oversees the outpatient prescription drug benefit for all Pennsylvania Medicaid-eligible beneficiaries and administers the pharmacy benefit for beneficiaries receiving services in the Fee-for-Service (FFS) program (i.e., ACCESS). The FFS pharmacy benefit encompasses all covered outpatient drugs as defined by the Social Security Act of 1927.
The pages linked below contain helpful information for providers and pharmacies rendering services in the FFS delivery system. Information regarding services administered in the Pennsylvania MA managed care delivery system is available from the specific managed care organizations.
Statewide Preferred Drug List (PDL)
Statewide PDL General Information
Statewide PDL Classes & Drugs
DHS Pharmacy & Therapeutics (P&T) Committee Information
Bureau of Fee-for-Service Programs
Covered Drug Search Tool
DHS Drug Utilization Review (DUR) Board Information
Prior Authorization General Requirements & Procedures
Prior Authorization Clinical Guidelines
Prior Authorization Fax Forms
Quantity Limits/Daily Dose Limits
Specialty Pharmacy Program
State MAC List
PROMISe
Claims Processing & Management System Information
Eligibility Verification System (EVI)
Error Status Codes & Descriptions
FFS Common Billing Errors for Drugs
Contact Information
If you have questions or need additional information regarding pharmacy services, please call the Pharmacy Services Help Desk at 1-800-537-8862. Hours are Monday-Friday, 8 a.m.-4:30 p.m.
Call the Pharmacy Services Help Desk
Additional Resources
DHS General Information
DHS Bulletin Search
DHS Medical Assistance Advisory Committee (MAAC) Information
DHS Centers of Excellence for Opioid Use Disorder
Information for 340B Covered Entities
Vaccines for Children Program (Pennsylvania Department of Health)