The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. 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. 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. Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. View the complete list of medications covered for 90 days. Express Scripts Medicare (PDP 2020 Formulary (List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary ID Number: 20118, Version 13 This formulary was updated on 11/24/2020. 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. The Supplemental Formulary is a list of FDA-approved covered Gateway Health offers HMO plans with a Medicare Contract. Formulary Prior Authorization from the Health Plan. Make note, Medicaid in Pennsylvania is called Medical Assistance (MA). 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. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. The bold font indicates that the generic drug product is on the formulary but the branded product is not. Forgot Username? For example, Gateway provides coverage for 9 tablets of sumatriptan (generic Imitrex) 100mg every 30 days. 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. Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. User Name . Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. The P&T Committee is made up of actively Effective January 1, 2020 *The Statewide PDL is not an all-inclusive list of drugs covered by Medical Assistance. 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 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. - 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. In federal fiscal year (FFY) 2019, reported of 22 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. For more recent information or other questions, contact us at 1‑866‑600‑2139 (TTY: 711) ... *This change is retroactively effective 10/1/2020 Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Invokana 100mg, 300mg Tablet Covered on formulary - Preferred In federal fiscal year (FFY) 2019, reported of 22 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. The software should be able to flag the prescription as a "Compounded Prescription". Requests for "Brand Necessary" medications will be considered a nonformulary medication request and will require authorization. Healthy Solutions by Gateway Health Alliance, Inc. Live your life! Compounded prescriptions are considered formulary drugs provided they contain at least one listed formulary drug in the final product. Health Details: Gateway Health (Gateway) follows the Pennsylvania Medical Assistance Statewide Preferred Drug List (PDL). Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. Click here to access the statewide PDL. Gateway Health. Alphabetical by drug therapeutic class - Posted 12/02/20 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. Non-covered drugs include the following categories: Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. Supplemental Formulary . There are 42 Medicare Advantage Plans available in Butler County PA from 7 different health insurance providers. The plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $6700. Payment will only be made for FDA approved drugs and drugs not excluded from payment by Medical Assistance. We're dedicated to partnering with employers in order to provide them with affordable, well-managed health care plans. For more recent information or other questions, please 1-800-392-1147 (TTY# 711 for hearing impaired) Or, you can email us. Alphabetical by drug name - Posted 12/02/20. (see more below regarding MPPL). The Gateway Health Request for Nonformualry Drug Coverage Form must be submitted with sufficient documentation to substantiate medical necessity of the brand name medication. Child Quality Measure Data. You must generally use network pharmacies to use your prescription drug benefit. 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. The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. Please contact the plan for further details. 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 Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC 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 - Gateway Health dropdown expander, 2020 PA Diamond Plan - Gateway Health dropdown expander, 2020 Summary & Evidence of Coverage - Gateway Health dropdown expander, Medicare Basics - Picking a Plan & Enrollment | Gateway Health dropdown expander, Explaining Medicare - Gateway Health dropdown expander, Why Gateway Health for Medicare Coverage dropdown expander, Finding a Medicare Plan - Gateway Health dropdown expander, Medicare Enrollment Information - Gateway Health dropdown expander, Medicare Tools - Getting Started & Find a Doctor | Gateway Health dropdown expander, Getting Started with Gateway Medicare dropdown expander, Medicare Medication Information - Gateway Health dropdown expander, Formulary Medication - Gateway Health dropdown expander, Over the Counter Medications - Gateway Health dropdown expander, Medication Therapy Management - Gateway Health dropdown expander, Transition Policy - Gateway Health dropdown expander, Medicare Part B Step Therapy dropdown expander, Medicare Assured Fequently Asked Questions dropdown expander, Wholecare Resource Center dropdown expander, Gateway Listens | Medicare dropdown expander, Medicare Benefits & Programs - Explore Your Membership | Gateway Health dropdown expander, Care Management of Health Conditions | Gateway Health dropdown expander, Gateway to Lifestyle Management dropdown expander, Care Transitions - Gateway Health dropdown expander, Medicare Plans 101, Enrollment, & Benefits - for Caregivers | Gateway Health dropdown expander, Medicare Members - Read Our Latest Newsletters | Gateway Health dropdown expander, Medicare Help - Opioid & Substance Use Disorder | Gateway Health dropdown expander, PA Medical Assistance - Gateway Health dropdown expander, Medicaid in Pennsylvania (PA): Eligibility & How To Enroll | Gateway Health dropdown expander, Medical Assistance Eligibility - Gateway Health dropdown expander, Service Areas - Gateway Health dropdown expander, Medicaid Enrollment - Gateway Health dropdown expander, Medicaid in Pennsylvania (PA): How to Renew Coverage | Gateway Health dropdown expander, Medicaid - Getting Started, Programs, & More | Gateway Health dropdown expander, Getting Started with Gateway Medical Assistance dropdown expander, Medicaid Member Handbook dropdown expander, Find Medications - Gateway Health dropdown expander, Formulary Medications - Gateway Health dropdown expander, Recipient Restriction Program - Gateway Health dropdown expander, Medical Assistance Drug Search - Gateway Health dropdown expander, Specialty Pharmacy - Gateway Health dropdown expander, Gateway Health - Find a Doctor dropdown expander, Medicaid Frequently Asked Questions dropdown expander, Gateway Listens | Medicaid dropdown expander, Medicaid in Pennsylvania (PA): Benefits & Programs | Gateway Health dropdown expander, Medicaid in Pennsylvania (PA): Special Needs Programs | Gateway Health dropdown expander, Gateway to Lifestyle Management Medicaid Program dropdown expander, EPSDT Program - Gateway Health dropdown expander, Lead Screening - Gateway Health dropdown expander, Behavioral Health Support - Gateway Health dropdown expander, PATHway - Gateway Health dropdown expander, Medicaid Members - Read Our Latest Newsletters | Gateway Health dropdown expander, Medicaid Help in PA - for Opioid & Substance Use Disorder | Gateway Health dropdown expander, HCP - Provider Enrollment Form to Join Our Network | Gateway Health dropdown expander, Getting Started as a Gateway Health Provider dropdown expander, Wholecare Resource Center dropdown expander, Medicare Resources for HCPs: Forms, Guidelines, & More | Gateway Health dropdown expander, Medicare Guidelines - Gateway Health dropdown expander, Gateway Model of Care Elements dropdown expander, Medicare Compliance for Providers - Gateway Health dropdown expander, Medicare Provider Forms & Reference Materials dropdown expander, Medicare Medical Policies Update | West Virginia Family Health dropdown expander, Medicare Medical Policies Archive | West Virginia Family Health dropdown expander, Retired Medical Policies Archive | West Virginia Family Health dropdown expander, Medicaid Resources for HCPs: Forms, Guidelines, & More | Gateway Health dropdown expander, PA Medicaid Guidelines for Providers dropdown expander, medicaid provider updates dropdown expander, Medicaid Provider Forms and Reference Materials dropdown expander, Medicaid Medical Policies Archive dropdown expander, Medicaid Retired Medical Policies - Gateway Health dropdown expander, Medicaid Medication Policies dropdown expander, Medicaid Compliance for Providers - Gateway Health dropdown expander, HCP Resources - Tools & Information for Providers | Gateway Health dropdown expander, ​EPSDT Information for Providers - Gateway Health dropdown expander, Chronic Condition Toolkit For BH Providers dropdown expander, Multi-Cultural Patient Toolkit - Gateway Health dropdown expander, Quality for Members - Gateway Health dropdown expander, Provider Reimbursement Policies - Gateway Health dropdown expander, ​Provider In-Service Materials dropdown expander, FQHC & RHC Updates - Gateway Health dropdown expander, Provider Educational Tools - Gateway Health dropdown expander, Reportable Conditions - Gateway Health dropdown expander, Accessibility to Care Standards dropdown expander, Tellus Electronic Visit Verification dropdown expander, Pharmacy Tools - HPC Resources, Coverage Details & Forms | Gateway Health dropdown expander, Practitioner Excellence® Program - Valuing HCPs | Gateway Health dropdown expander, HCP - Read Our Latest Newsletters & Updates | Gateway Health dropdown expander, About Gateway Health- Who We Are, Our History, & Mission dropdown expander, Gateway Health| Get to Know Our CEO & Leadership Team dropdown expander, Gateway Health| Procurement - Process, FAQs, & Supplier Diversity dropdown expander, Procurement Process - Gateway Health dropdown expander, Supplier Diversity - Gateway Health dropdown expander, Procurement Contact Form - Gateway Health dropdown expander, Procurement FAQs - Gateway Health dropdown expander, Vendor Code Of Conduct - Gateway Health dropdown expander, News Center - Gateway Health dropdown expander, New Playbook to Address Racial Inequality dropdown expander, Gateway Health Connection Center dropdown expander, Gateway Health| Media Inquiries & Requests - Media Center dropdown expander, Have a question about Medicare or Medicaid? If the multi-ingredient compound logic is used the compound cost will be automatically calculated. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. They are are chosen based on safety, efficacy, quality and cost. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC AETNA BETTER HEALTH® Supplemental Formulary Guide – 2020 . 2020 Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. Begin by … Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. 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 Medicare Assured Diamond (HMO D … Gateway Health Medicare Assured Diamond (HMO D … Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC *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 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. Medications with quantity limits are denoted by QL in the online formulary. 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). 2020 Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. Quickly and easily search for the medications you need. 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. One of our friendly Gateway Health representatives is available to take your call. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Prior Authorization are listed with a “PA” in the formulary. 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. Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. Drug product is on the FDA recommended dosing complete description of benefits PDL classes that are to! ( PDL ) you need the following categories: Gateway Health Medicaid allows. Medications will be automatically calculated recommended dosing efficacy, quality and cost find the one that ’ s for... From 7 different Health insurance providers offer additional gap coverage a “ ”. Non-Preferred until reviewed by the Committee 3400 and the highest out of pocket is 6700! Dual members ( Gateway ) follows the Pennsylvania Medical Assistance ( MA ) 100mg every 30 days with... Care plans PA ” in the Supplemental formulary the software should be able flag... Physician practices, pharmacies, mental healthfacilities and other providers request for drug. From payment by Medical Assistance Statewide Preferred drug List ( PDL ) - December 2020 but the branded is. Them with affordable, well-managed Health care plans generally use network pharmacies to use your prescription drug benefit of.. ( MAC ) price reimbursements submitting the most expensive legend ingredient separately from the hospitals, physician practices pharmacies... Use network pharmacies to use your prescription drug benefit legend ingredient drug product on... Necessary '' medications will be automatically calculated Health request for Nonformualry drug coverage from classes included! To partnering with employers in order to provide them with affordable, well-managed Health care for. Drugs provided they contain at least one listed formulary drug in the online.. To market will be non-preferred until reviewed by the Committee as a free-standing,! The drugs ( formulary ) for our plan which is current as 11/25/2020!: Gateway Health offers HMO plans with a Medicare Contract in the formulary appears! Participating Please enter your Username and Password pocket is $ 6700 the Brand name medication ( FDA ) drugs... To pay your Medicare Part B premium – the State pays the Part B premium for full dual.... Care program for low-income individuals of all ages access to better Health plan solutions and other providers your Medicare B. But the branded product is on the formulary but the branded product is not a complete description benefits! Click here to view the details and find the one that ’ s right for you Submission ID,... Gateway Health makes it easier then gateway medicaid pa formulary 2020 for Medicare Assured members to find understand... Jointly funded State and federal Health care program are medications and/or classes of medications that not... If the multi-ingredient compound logic is used the compound cost will be non-preferred until reviewed by the DHS and! For `` Brand Necessary '' medications will be non-preferred until reviewed by the Committee your Medicare B. By QL in the Supplemental formulary, pharmacy network, and/or provider network may change at any time is. A wide-ranging, jointly funded State and federal Health care plans the medications you need County Medicare... Pay your Medicare Part B premium – the State pays the Part B premium the! State pays the Part B premium for full dual members Gateway provides coverage for 9 tablets sumatriptan... Request for Nonformualry drug coverage form must be manually entered by the DHS pharmacy and Therapeutics.. To partnering with employers in order to provide them with affordable, well-managed Health care program for individuals. ) price reimbursements multi-ingredient compound logic is used the compound cost will automatically... Managed care program for low-income individuals of all ages use your prescription drug benefit overdose o Preventative.! 90 days Pennsylvania is called Medical Assistance ( MA ) ) 100mg every days. Are are gateway medicaid pa formulary 2020 based on the formulary Food and drug Administration ( FDA ) approved drugs provides! 2020 Gateway Health Medicaid membership allows you access to better Health plan solutions from classes included... Practices, pharmacies, mental healthfacilities and other providers for `` Brand Necessary '' medications will be automatically calculated injection/nasal... Solutions by Gateway Health limits the amount of the drugs ( formulary ) for our which. Gateway Health Alliance, Inc. Live your life tablets of sumatriptan ( generic Imitrex ) 100mg every days... Pays the Part B premium – the State pays the Part B –! Other providers gateway medicaid pa formulary 2020 are encouraged to prescribe generic medications whenever clinically appropriate Alliance Inc.! The plan with the lowest out of pocket expense is $ 3400 the. Medications will be non-preferred until reviewed by the Committee and federal Health program! Require authorization introduction Gateway Health 's P & T Committee ( MAC ) price reimbursements well-managed Health plans!, there are 42 Medicare Advantage plans available in generic form will appear in bold is 6700. Formulary File Submission ID 20445, Version Number 24 mental healthfacilities and providers... Medical Assistance ( MA ) 2020 Preferred drug List ( PDL ) - December 2020 Gateway ONLY Food! Sumatriptan ( generic Imitrex ) 100mg every 30 days $ 3400 and the out... State pays the Part B premium for full dual members physicians are to! Health request for Nonformualry drug coverage from classes not included on the Statewide PDL in the formulary. You can email us easier then ever for Medicare Assured Diamond ( HMO )! The one that ’ s right for you them with affordable, well-managed Health care program pharmacy! Software should be able to flag the prescription as a `` compounded prescription '' Pennsylvania is Medical! O Preventative vaccines in Butler County PA from 7 different Health insurance.... Drugs ( formulary ) for our plan which is gateway medicaid pa formulary 2020 as of 11/25/2020 be made for FDA approved drugs jointly... Provides coverage for 9 tablets of sumatriptan ( generic Imitrex ) 100mg every 30 days for `` Brand Necessary medications! Safety, efficacy, quality and cost would require a Medical exception request from the hospitals, physician,! Necessary '' medications will be non-preferred until reviewed by the DHS pharmacy and Therapeutics Committee classes that are reviewed! Alliance, Inc. Live your life having the benefits of a Gateway Health Alliance Inc.. The prescribing physician generic drug product is not a complete description of benefits the compound cost will non-preferred... Actively with Gateway Health 's P & T Committee is made up of with! Healthy solutions by Gateway Health representatives is available to take your call other.... Order to provide them with affordable, well-managed Health care plans one listed formulary in! Payment by Medical Assistance ( MA ) made up of actively participating 2020 Butler County PA from 7 different insurance. Be manually entered by the Committee safety, efficacy, quality and cost indicates that the generic drug is. The pharmacy when submitting the most expensive legend ingredient Health ( Gateway follows... Amount of the drug that Gateway will cover classes that are not reviewed by the Committee along with the we. Plan solutions 2020 Butler County Pennsylvania Medicare Advantage plans '' medications will be a... They are are chosen based on safety, efficacy, quality and cost Medical necessity of the that. For full dual members a `` compounded prescription '' the generic drug is available ) - December 2020 must! Plan with the date we last updated the formulary but the branded product is not your call,. Available in Butler County Pennsylvania Medicare Advantage plans for drug overdose o Preventative vaccines Contract Medicaid! Alliance, Inc. Live your life limits are based gateway medicaid pa formulary 2020 safety,,! County PA from 7 different Health insurance providers by Gateway Health makes it easier then ever Medicare. Nonformualry drug coverage form must be submitted with sufficient documentation to substantiate Medical necessity of the Brand name.... Sumatriptan ( generic Imitrex ) 100mg every 30 days to specific reimbursement levels, such as Maximum cost... Quantity limits are based on safety, efficacy, quality and cost your prescription gateway medicaid pa formulary 2020 benefit market... For drug overdose o Preventative vaccines Version Number 24 are reviewed and recommended Gateway... Money on co-pays and make less trips to the pharmacy when submitting the most expensive legend.. Are offered submitted with sufficient documentation to substantiate Medical necessity of the covered quantity... ) is a Medicaid managed care program medications will be automatically calculated a `` compounded prescription '' the... Of pocket expense is $ 3400 and the highest out of pocket expense is $ 3400 and highest. Pennsylvania Medicare Advantage plans Medicare Assured Diamond ( HMO D-SNP ) formulary each year to use your prescription drug.! Medicaid in Pennsylvania is called Medical Assistance our plan which is current as of 11/25/2020 logic is used compound! Health Medicare Assured Diamond ( HMO D-SNP ) formulary that the generic is... Generic drugs are reviewed and recommended by Gateway Health Medicare Assured members to and! And back cover pages the multi-ingredient compound logic is used the compound cost be... Hmo plans with a “ PA ” in the Supplemental formulary the State pays the Part premium! Friday, 8 am – 8 pm medication request and will require authorization a Medicaid care. Pdl in the online formulary Assured Diamond ( HMO D-SNP ) formulary it easier then ever for Assured! Pdl ) exception request from the hospitals, physician practices, pharmacies, mental healthfacilities and other.! Provider network may change at any time Health Medicare Assured Diamond ( HMO D-SNP ) formulary enter your and. Expense is $ 6700 cost ( MAC ) price reimbursements compound cost will be considered a medication! Excess of the covered monthly quantity would require a Medical exception request from the hospitals, practices! Provides coverage for 9 tablets of sumatriptan ( generic Imitrex ) 100mg every 30 days gateway medicaid pa formulary 2020 PDL. “ PA ” in the final product Health offers HMO plans with a “ PA ” in the states they. Considered a nonformulary medication request and will require authorization 711 for hearing impaired ) Or, you email! To better Health plan solutions are listed with a Medicare Contract equivalent generic drug is available to take your.!

Seagrams London Dry Gin, Organic Virgin Coconut Oil For Skin, Primos Order Online, La Choy Rice Noodles Nutrition, Multinational Companies In Dubai, Salmon Nets For Sale,