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Medicaid Plan
Find a Covered Drug

The Health Partners Plans Medicaid formulary is a list of the preferred drugs that are covered by your health plan. You can also use the formulary to find out about medication side effects, interactions and proper usage.

Search the Formulary
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Statewide Preferred Drug List

The Department of Human Services (DHS) has implemented a Preferred Drug List (PDL) for all Pennsylvania Medicaid members. Click the link below to access the statewide PDL.

Preferred Drug List
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Specialty Medications and Pharmacies

Specialty medications are prescription drugs that require special handling, administration or monitoring. These medications treat complex chronic conditions and are only available from a specialty pharmacy. Health Partners Plans works with a network of specialty pharmacies to coordinate the delivery of specialty medications for our members.

For more information about specialty medications and pharmacies, please call Member Relations at 1-800-553-0784 (TTY: 1-877-454-8477).

Formulary Changes
Prior Authorizations

Some services, medicines, or items need approval from Health Partners before you can get the service. This approval process is called prior authorization. “Prior authorizations” are sometimes referred to as “preauthorizations” or “precertifications” or “preapprovals” – they mean the same thing.

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Over-the-Counter Medicines

Health Partners Plans’ Medicaid covers over-the-counter medicines when you have a prescription from your provider. You will need to have your Health Partners Plans ID card with you. The following are some examples of over-the-counter medicines that may be covered:

  • Sinus and allergy medicine
  • Tylenol or aspirin
  • Vitamins
  • Cough medicine
  • Heartburn medicine such as antacids and famotidine
  • Vaporizers
For More Information
  • Call Member Relations at 1-800-553-0784 (TTY 1-877-454-8477).
  • Health Partners members can also view pharmacy claims and other prescription benefit information including financial responsibility for a drug and initiate a prior authorization (formulary exception) request on our pharmacy portal.
Frequently Asked Questions

The Health Partners Plans Medicaid formulary contains two kinds of drugs: brand name and generic. This could affect which medications you get when using your benefit. When you search for a brand name drug on the formulary, you will see a generic equivalent (if available). View our formulary for more information.

Health Partners Plans Medicaid works with local doctors and pharmacists to select the drugs in the formulary. We choose drugs that are safe, effective and high quality. New drugs and treatments are reviewed regularly. We make changes to the formulary as needed.

Your PCP must ask us to approve for you. This is known as prior authorization. When we receive a complete request for prior authorization, we will contact you by phone within two business days from the date we received the request to tell you if we approved the service or item requested. To learn more, click here.

Health Partners Plans Medicaid typically limits medications to a 30-day supply. However, we offer an option for inexpensive chronic medications to be dispensed for a 90-day supply. This list is subject to change without notice.

A 90-day supply is also available through our mail order pharmacy, Caremark. Getting your prescriptions by mail is convenient. You will never miss a refill. You must have a valid prescription to use this service. Please note, not all covered drugs are available for mail order. To view the complete list of 90 days’ supply medications, click here. To learn more, call 1-800-756-7186 or visit Caremark.com/mailservice.

To view a drug recall list, click here. If you are impacted by a drug recall, you will receive a drug recall notice from Health Partners Plans Medicaid.

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