Thank you for your continuing efforts to improve the health outcomes of our members. This letter is to inform you of the changes the Department of Human Services (DHS) announced to prior authorization guidelines for Analgesics, Opioid Long Acting and Short Acting for all Pennsylvania Medical Assistance Members starting July 10, 2023.

The DHS Drug Utilization Review (DUR) Board recommended several revisions to the Analgesics, Opioid guidelines based on the November 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain. The full guidelines and revisions can be found on the Pennsylvania Statewide PDL website at: www.dhs.pa.gov/providers/Pharmacy-Services/Pages/Clinical-Guidelines.aspx

For your convenience, please find the new standardized prior authorization forms at www.HPPlans.com/PriorAuth

For more information, call our Pharmacy department at 1-866-841-7659 or our Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. to 5:30 p.m.).