Pharmacy and Therapeutics Committee (P&T)The PA Health & Wellness Pharmacy and Therapeutics (P&T) Committee continually evaluates the therapeutic classes included in the PDL. The primary purpose of the Committee is to assist in developing and monitoring the PA Health & Wellness PDL in establishing programs and procedures that promote the appropriate and cost-effective use of medically necessary medications. The P&T Committee
78 schedules meetings 4 times a year, and coordinates reviews with the National P&T Committee’s meeting schedule. All changes to the PDL are done in conjunction with the Common Wealth of Pennsylvania and revisions to PA Health & Wellness PDL that adversely impacts our Participants will be communicated at least 30-days in advance of those changes. PA Health & Wellness will submit proposed changes to the PDL and Prior Authorization criteria to the Commonwealth for approval, based on the results of the PA Health & Wellness P&T Committee. PA Health & Wellness will follow all State policies regarding participant notification when changes are made to the PA list. Unapproved Use of Preferred MedicationMedication coverage under this program is limited to non-experimental indications as approved by the FDA. Other indications may also be covered if they are accepted as safe and effective using current medical and pharmaceutical reference texts and evidence-based medicine. Reimbursement decisions for specific non-approved indications will be made by PA Health & Wellness. Experimental drugs and investigational drugs are not eligible for coverage. Prior Authorization ProcessThe PA Health & Wellness PDL includes a broad spectrum of brand name and generic drugs. Clinicians are encouraged to prescribe from the PA Health & Wellness PDL for their patients who are Participants of PA Health & Wellness. Some drugs will require PA (Prior Authorization) and are listed on the PA list. In addition, all drugs not listed on either the PDL or PA list will require prior authorization. If a request for Prior Authorization is needed the information should be submitted by the physician/clinician to Envolve Pharmacy Solutions on the PA Health & Wellness/Envolve Pharmacy Solutions form: Medication Prior Authorization Request Form. This form should be faxed to Envolve Pharmacy Solutions at 1-866-399-0929. This document is located on the PA Health & Wellness website at PAHealthWellness.com. PA Health & Wellness will cover the medication if it is determined that: 1. There is a medical reason the Participant needs the specific medication. 2.Depending on the medication, other medications on the PDL have not worked. Prior Authorization requests for specialty medications should be faxed to the PA Health and Wellness pharmacy department at 844-348-6546.