MAB2025111203

By December 6, 2025 (60 days before effective date): (1) Billing team must access the updated Statewide PDL at https://papdl.com/preferred-drug-list and document all therapeutic class changes, preferred/non-preferred status changes, and new quantity limits. (2) Update billing system logic to enforce new PDL statuses and quantity limits for all PA Medical Assistance claims effective January 5, 2026. (3) Update prior authorization procedures in billing software based on revised clinical guidelines (publish separately per bulletin). (4) For FFS beneficiaries: Train billing and prior authorization staff on new requirements in the Prior Authorization of Pharmaceutical Services Handbook Section I and Section II. (5) For managed care beneficiaries: Contact each MCO (Physical Health HealthChoices and Community HealthChoices) to confirm MCO-specific prior authorization procedures, as they may differ from FFS procedures despite using same clinical guidelines. (6) Pharmacy staff must review new quantity limits and flag prescriptions exceeding limits for prior authorization. Failure to implement changes by January 5, 2026 will result in claim denials for non-compliant prescriptions and potential program violations. Note: Provider enrollment revalidation reminder—verify all service locations' revalidation dates in PROMISe system and submit applications 60 days prior to expiration.