MedicaidAdministrativeMedium impact
MAB2022122201
Pennsylvania Medicaid (DHS)·PA · Oncology, Pharmacy·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has established new procedures for 340B covered entities dispensing discounted drugs to Medicaid beneficiaries, including a drug exclusion list that prohibits 340B pricing for certain high-cost gene and cell therapies. This policy clarifies billing requirements and prevents duplicate discounts between 340B program savings and Medicaid rebates.
Action Required
By January 1, 2023: 340B covered entities in Pennsylvania must verify their NPI is listed on the HRSA Medicaid Exclusion File if dispensing 340B-purchased drugs to Medicaid beneficiaries. Billing teams must ensure drugs on the PA 340B Drug Exclusion List (including Abecma, Breyanzi, Carvykti, Kymriah, Luxturna, Tecartus, Yescarta, Zolgensma, and Zynteglo) are billed as non-340B purchases only. Contract pharmacies and out-of-state entities must dispense non-340B drugs to all PA Medicaid beneficiaries.