Q: What is a PDL?
A: PDL stands for Preferred Drug List. The Preferred Drug List is a list of medicines that are considered “first choice” medicines by the Department of Public Welfare. These medicines are chosen by the Department’s Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is a group of doctors, pharmacists and Medical Assistance consumers or advocates. The P&T Committee considers each medicine for its safety and effectiveness. The medicines that are the most safe and the most effective are put on the Preferred Drug List as preferred or “first choice” drugs. If some medicines used for the same problem are considered to be equally safe and effective, then cost will be considered in the decision of which drug will be called Preferred on the Preferred Drug List. The Preferred Drug List also lists the medicines that are Non-Preferred. The non-preferred drugs are still covered by the Department after preferred drugs are tried and the non-preferred drug is medically necessary. Your doctor can call the Department’s Pharmacy Prior Authorization Call Center (1-800-558-4477 ) to request prior authorization for Non-Preferred drugs.
Q: How does the PDL work?
A: If you have a prescription for a drug that is listed as preferred on the PDL, you may take it to the pharmacy and get it filled as you always have in the past. But please note that some preferred drugs require prior authorization when the quantity is higher than recommended or the drug should only be used to treat specific medical problems.
If you have a prescription for a drug that is listed as Non-Preferred on the PDL, your doctor will need to call the Department’s Pharmacy Prior Authorization Call Center. Your doctor will request prior authorization of the drug. A prior authorization is granted when the non-preferred drug is medically necessary because you cannot take the preferred medicine for a medical reason. If a prior authorization is approved you will be able to get the non-preferred medication.
If you have a prescription for a drug that is not listed on the PDL at all you may take it to the pharmacy and have it filled as you always have in the past.
Q: What is the Pharmacy and Therapeutics Committee (P&T)?
A: The P&T Committee is a group of doctors, pharmacists and MA consumers or advocates. The Committee meets once every quarter to review new drugs that are available as well as review drugs reviewed at an earlier meeting to make sure that the Preferred Drug List contains preferred drugs that are best at treating the medical conditions of the Medical Assistance Consumers. The meetings are open to the public and announcements of when and where the meetings are available on this Web site.
Q: What happens when a drug is denied?
A: A letter is sent to both the consumer and the doctor explaining why the medicine was denied and how to file an appeal on the decision.
If you cannot find the question or answer you need, please Contact DPW.