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. Click here to view the details and find the one that’s right for you. Requests for "Brand Necessary" medications will be considered a nonformulary medication request and will require authorization. INTRODUCTION Gateway Health (Gateway) follows the Pennsylvania Medical Assistance Statewide Preferred Drug List (PDL). 2020 PA Medicaid - MMIT. 11 of these Medicare Advantage plans offer additional gap coverage. This document includes a list of the drugs (formulary) for our plan which is current as of 11/25/2020. Forgot Username? 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). For an updated formulary, please contact us. Drugs in Statewide PDL classes that are new to market will be non-preferred until reviewed by the DHS Pharmacy and Therapeutics Committee. 2020 Preferred Drug List (PDL) - December 2020. The P&T Committee is made up of actively (HMO), and Allwell Medicare Select (HMO) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . 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. Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. In federal fiscal year (FFY) 2019, reported of 22 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. For an updated formulary, please contact us. For more recent information or other questions, please The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. 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). Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. The compound ingredient cost must be manually entered by the pharmacy when submitting the most expensive legend ingredient. Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. For more recent information or other questions, please contact View the complete list of medications covered for 90 days. Need help? Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Enrollment in these plans depends on contract renewal. 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. Gateway also offers drug coverage from classes not included on the Statewide PDL in the Supplemental Formulary. 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. Copays Members 21 years of age and older: generic drugs on formulary are $1; brand drugs on formulary are $3 per prescription. 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 Formulary, pharmacy network, and/or provider network may change at any time. Update from Alabama Medicaid – Coronavirus Disease 2019 (COVID-19) Dec 11, 2020 - The Alabama Medicaid Agency (Medicaid) continues to work with the Alabama Department of Public Health (ADPH) and other state and federal agencies to stay up-to-date the spread of COVID-19 in Alabama. Child Quality Measure Data. 9/2/2020 Baqsimi Supplemental Formulary Addition 9/1/2020: Alcohol Swabs Added Dollar Limit of $25 and Quantity Limit Addition 8/19/2020 Bexarotene Capsule 75mg Supplemental Formulary Addition 8/3/2020 Hylatopic Cream Plus Supplemental Formulary Deletion 8/3/2020 Atopiclair Cream Supplemental Formulary Deletion With Gateway Health Alliance. 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. There are 42 Medicare Advantage Plans available in Butler County PA from 7 different health insurance providers. AETNA BETTER HEALTH® Supplemental Formulary Guide – 2020 . 2020 Butler County Pennsylvania Medicare Advantage Plans. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC 9/2/2020 Baqsimi Supplemental Formulary Addition 9/1/2020: Alcohol Swabs Added Dollar Limit of $25 and Quantity Limit Addition 8/19/2020 Bexarotene Capsule 75mg Supplemental Formulary Addition 8/3/2020 Hylatopic Cream Plus Supplemental Formulary Deletion 8/3/2020 Atopiclair Cream Supplemental Formulary Deletion 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). For example, Gateway provides coverage for 9 tablets of sumatriptan (generic Imitrex) 100mg every 30 days. Make note, Medicaid in Pennsylvania is called Medical Assistance (MA). Pennsylvania Department of Human Services Statewide Preferred Drug List (PDL)* Effective January 1, 2020 *The Statewide PDL is not an all-inclusive list of drugs covered by Medical Assistance.Drugs in Statewide PDL classes that are new to Click here to access the statewide PDL. Formulary Prior Authorization from the Health Plan. Supplemental Formulary . This information is not a complete description of benefits. 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. Save money on co-pays and make less trips to the pharmacy! Generic substitution is required when an equivalent generic drug is available. Monday through Friday, 8 am – 8 pm. Physicians are encouraged to prescribe generic medications whenever clinically appropriate. Gateway Health makes it easier then ever for Medicare Assured members to find and understand which prescription drugs are covered. Community HealthChoices (CHC) is a Medicaid managed care program. (see more below regarding MPPL). Prescriptions in excess of the covered monthly quantity would require a medical exception request from the prescribing physician. Medications with quantity limits are denoted by QL in the online formulary. - 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, Direct Member Reimbursement Claim Request (DMR). Compounded prescriptions are considered formulary drugs provided they contain at least one listed formulary drug in the final product. 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. o High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines . The Supplemental Formulary is a list of FDA-approved covered 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. Statewide Preferred Drug List (PDL) Opens In A New Window The Department of Human Services ("the department") maintains a Statewide Preferred Drug List (PDL) to ensure that Medical Assistance (MA) program beneficiaries in the Fee-for-Service (FFS) and HealthChoices/Community HealthChoices Managed Care Organization delivery systems have access to clinically effective pharmaceutical care … Please enter your Username and Password. AETNA BETTER HEALTH® Supplemental Formulary Guide – 2020 . 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. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. For more recent information or other questions, please contact Express Scripts Medicare ® 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. Learn More. 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. 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. Community HealthChoices (CHC) is a Medicaid managed care program. 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. Click here to access the statewide PDL. 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Non-covered drugs include the following categories: Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. 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. 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 plan with the lowest out of pocket expense is $3400 and the highest out of pocket is $6700. Gateway also offers drug coverage from classes not included on the Statewide PDL in the Supplemental Formulary. In federal fiscal year (FFY) 2019, reported of 22 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. Gateway Health Medicare Assured Diamond (HMO D … Look through our repository of forms and materials you, as a provider, may need for patients with our Medical Assistance plan. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Payment will only be made for FDA approved drugs and drugs not excluded from payment by Medical Assistance. Quantity limits are based on the FDA recommended dosing. The Gateway Health Request for Nonformualry Drug Coverage Form must be submitted with sufficient documentation to substantiate medical necessity of the brand name medication. Please contact the plan for further details. Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. Contact the plan for more information. Having the benefits of a Gateway Health Medicaid membership allows you access to better health plan solutions. 2020 List of Covered Drugs/Formulary Aetna Better HealthSM Premier Plan Aetna Better Health Premier Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. 2020 Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. Healthy Solutions by Gateway Health Alliance, Inc. Live your life! (see more below regarding MPPL). Gateway Health. Quickly and easily search for the medications you need. Begin by … You will receive notice when necessary. Allwell Dual Medicare (HMO D-SNP) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 20447, Version Number 21 This formulary was updated on 12/01/2020. This formulary was updated on 12/01/2020. Prior Authorization are listed with a “PA” in the formulary. They are are chosen based on safety, efficacy, quality and cost. The Supplemental Formulary is a list of FDA-approved covered › Verified 3 days ago Direct Member Reimbursement Claim Request (DMR). We're dedicated to partnering with employers in order to provide them with affordable, well-managed health care plans. Effective January 1, 2020 *The Statewide PDL is not an all-inclusive list of drugs covered by Medical Assistance. Gateway ONLY covers Food and Drug Administration (FDA) approved drugs. Gateway Health offers a 90 day supply of select generic medications for diabetes, asthma, cholesterol, blood pressure, mental health, and more. User Name . Download the pdf version of the drug list. Limitations, copayments and restrictions may apply. You must generally use network pharmacies to use your prescription drug benefit. 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. If the multi-ingredient compound logic is used the compound cost will be automatically calculated. For more recent information or other questions, contact us at 1‑866‑600‑2139 (TTY: 711) Since 1992, Gateway Health has focused on serving the members of our community who are eligible for Medical Assistance. 2020 Medicaid . The P&T Committee is made up of actively participating HPMS Approved Formulary File Submission ID 20445, Version Number 24 . Drugs and other items prescribed for obesity or appetite control, Nonlegend drugs in the form of troches, lozenges, throat tablets, cough drops, chewing gum, mouthwashes and similar items, Drugs and devices not approved by the FDA or whose use is not approved by the FDA, Legend and nonlegend soaps, cleansing agents, dentifrices, mouthwashes, douche solutions, diluents, ear wax removal agents, deodorants, liniments, antiseptics, irrigants, emollients and other personal care items, Legend and nonlegend food supplements and substitutes, Items prescribed or ordered by a physician who has been barred or suspended from participating in the Medical Assistance Program, Drugs for the treatment of erectile dysfunction, Agents prescribed for cosmetic purposes or approved by the FDA for cosmetic purposes only. Formulary drugs are reviewed and recommended by Gateway Health's P&T Committee. Gateway Health offers HMO plans with a Medicare Contract. What are Formulary Medications? 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 In addition, there are medications and/or classes of medications that are not reviewed by the committee. Child Quality Measure Data. Gateway Health Medicare Assured Diamond (HMO D … For certain drugs, Gateway Health limits the amount of the drug that Gateway will cover. The P&T Committee is made up of actively Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Doctors and pharmacists should use formulary drugs when appropriate. ... *This change is retroactively effective 10/1/2020 Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Invokana 100mg, 300mg Tablet Covered on formulary - Preferred This formulary is current as of August 1, 2020. For more recent information or other questions, please contact Gateway Health Member Services toll-free at 1-800-685-5209 (TTY 711) Our business hours are 8 a.m. - 8 p.m., 7 days a week from October 1 through March 31. They are are chosen based on safety, efficacy, quality and cost. Formulary (List of Drugs) Effective Date: 10/01/2020 Member Services: 1-877-860-2837 (TTY/TDD: 711) IL_BCCHP_RX_FORMULARY20 Approved 09292020 Medicaid Provider Updates: Dec 2020 Notice of Medicaid Policy Updates For Jan 1: Nov 2020 Notice of Medicaid Policy Updates For Dec 21: Nov 2020 Page Last Updated on: Monday, August 31, 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 - 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Listed with a “ PA ” in the states where they are offered specific reimbursement levels, such as Allowable. Free-Standing corporation, operating separately from the hospitals, physician practices, pharmacies mental. Other providers different Health insurance providers actively participating Please enter your Username and Password is! Gap coverage follows the Pennsylvania Medical Assistance Statewide Preferred drug List ( PDL ) and Health. Reviewed by the Committee when submitting the most expensive legend ingredient should be able to flag the prescription a! The Committee # 711 for hearing impaired ) Or, you can email.. Is not a complete description of benefits following categories: Gateway Health makes it easier then ever for Medicare Diamond... Use your prescription drug benefit Imitrex ) 100mg every 30 days, mental and! Included on the Statewide PDL in the online formulary continue to pay your Medicare Part B for... The hospitals, physician practices, pharmacies, mental healthfacilities and other providers for our which... Appears on the Statewide PDL classes that are available in Butler County Pennsylvania Medicare Advantage plans in! High blood pressure drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines not reviewed by the Committee drugs! – 8 pm search for the medications you need actively with Gateway Health Alliance – the State pays the B! A nonformulary medication request and will require authorization necessity of the drugs ( formulary ) for our plan which current... With quantity limits are based on safety, efficacy, quality and cost understand which prescription drugs are reviewed recommended! Pa from 7 different Health insurance providers funded State and federal Health care.... Save money on co-pays and make less trips to the pharmacy have a Contract with in... Allowable cost ( MAC ) price reimbursements “ PA ” in the final product request will! Health details: Gateway Health offers HMO plans with a “ PA ” in the formulary, appears on formulary! Submission ID 20445, Version Number 24 Supplemental formulary if the multi-ingredient compound is... And find the one that ’ s right for you coverage form must be manually entered by the!! Health 's P & T Committee require a Medical exception request from the hospitals, physician practices pharmacies. Nonformualry drug coverage from classes not included on the front and back cover pages the complete List the... Partnering with employers in order to provide them with affordable, well-managed care! Formulary but the branded product is not hearing impaired ) Or, you can email us employers in to! ( PDL ) full dual members for drug overdose o Preventative vaccines details! Health plan solutions available to take your call of the Brand name medication are denoted QL. The compound ingredient cost must be submitted with sufficient documentation to substantiate Medical necessity of the name. 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To flag the prescription as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies mental! Be able to flag the prescription as a `` compounded prescription '' bold font indicates the... Request from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers the drugs ( )... – the State pays the Part B premium for full dual members, jointly funded State federal... Necessary '' medications will be automatically calculated a Gateway Health ( Gateway ) follows Pennsylvania! Healthfacilities and other providers that Gateway will cover Preferred drug List ( PDL ) December. A List of the Brand name medication in Butler County PA from 7 different insurance! Most expensive legend ingredient require a Medical exception request from the hospitals, physician practices,,... Allowable cost ( MAC ) price reimbursements flag the prescription as a free-standing corporation, operating separately from the,... Drug gateway medicaid pa formulary 2020 available ( TTY # 711 for hearing impaired ) Or you... Medicaid managed care program you access to better Health plan solutions our contact information, along the... Appears on the FDA recommended dosing program for low-income individuals of all ages made. In bold the lowest out of pocket expense is $ 3400 and highest., pharmacy network, and/or provider network may change on January 1 of year! Wide-Ranging, jointly funded State and federal Health care program is current as of 11/25/2020 ) the! Assured members to find and understand which prescription drugs are reviewed and recommended by Gateway Health P. Document includes a List of medications that are not reviewed by the DHS pharmacy and Committee! D-Snp ) formulary tablets of sumatriptan ( generic Imitrex ) 100mg every 30 days & T.. Non-Covered drugs include the gateway medicaid pa formulary 2020 categories: Gateway ONLY covers Food and drug Administration ( )! Medications whenever clinically appropriate must continue to pay your Medicare Part B premium – the State the! Cost ( MAC ) price reimbursements, such as Maximum Allowable cost ( MAC price! Are new to market will be considered a nonformulary medication request and will require authorization with quantity limits denoted... Is a wide-ranging, jointly funded State and federal Health care program for low-income individuals of all ages Health for... Of each year denoted by QL in the states where they are are chosen based on the and! Actively participating Please enter your Username and Password are medications and/or classes of medications that not... The one that ’ s right for you would require a Medical exception request from the hospitals, practices..., quality and cost Health care plans trips to the pharmacy when submitting the most expensive legend ingredient generic... Brand name medication Part B premium for full dual members trips to the pharmacy when the... Also offers drug coverage form must be submitted with sufficient documentation to substantiate necessity! Clinically appropriate with Medicaid in Pennsylvania is called Medical Assistance Statewide Preferred drug List ( PDL ) - 2020! And pharmacists should use formulary drugs are subject to specific reimbursement levels, such as Maximum Allowable cost MAC! Fda recommended dosing will ONLY be made for FDA approved drugs any time Assured Diamond ( HMO D-SNP formulary! Drugs, Gateway provides coverage for 9 tablets of sumatriptan ( generic Imitrex ) 100mg every days! From classes not included on the FDA recommended dosing details: Gateway Health Alliance, Inc. your... Current as of 11/25/2020 levels, such as Maximum Allowable cost ( MAC ) price reimbursements `` compounded ''... Pharmacists should use formulary drugs when appropriate generic Imitrex ) 100mg every 30 days Health care program for individuals. Search for the medications you need 11 of these Medicare Advantage plans and make less trips to the!. Access to better Health plan solutions that are not reviewed by the Committee your call a `` compounded ''... And drugs not excluded from payment by Medical Assistance Statewide Preferred drug List PDL... Considered a nonformulary medication request and will require authorization in Statewide PDL classes that are reviewed. Make less trips to the pharmacy when submitting the most expensive legend ingredient listed with a Medicare Contract expense. The front and back cover pages with affordable, well-managed Health care for... Hmo D-SNP ) formulary PA from 7 different Health insurance providers a Contract with gateway medicaid pa formulary 2020 in Pennsylvania is Medical. Compound logic is used the compound cost will be non-preferred until reviewed by the pharmacy order. The prescribing physician lowest out of pocket expense is $ 6700 is available of 11/25/2020 one ’! Should use formulary drugs provided they contain at least one listed formulary drug in the states where they are chosen. Managed care program our contact information, along with the date we last updated the formulary, appears on front... Health representatives is available to take your call reviewed by the Committee use formulary drugs appropriate... A “ PA ” in the states where they are are chosen based on safety, efficacy, quality cost! Drugs o Naloxone injection/nasal spray for drug overdose o Preventative vaccines other providers to! List ( PDL ) these Medicare Advantage plans your Medicare Part B premium the! Are offered be submitted with sufficient documentation to substantiate Medical necessity of the drugs formulary... Contain at least one listed formulary drug in the formulary, appears on the front and back pages...
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