MedicaidCoverageHigh impact
MAB2020052701
Pennsylvania Medicaid (DHS)·PA · Pharmacy, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Mar 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has implemented temporary COVID-19 pharmacy policy changes including waived copayments for COVID-related medications, 90-day prescription supplies, coverage for adult cough/cold medications, hydroxychloroquine limits, and expanded preferred albuterol alternatives. These changes remain in effect during the federal COVID-19 public health emergency.
Action Required
Immediately: Billing team must update pharmacy billing procedures to: 1) Not collect copayments for COVID-19 treatment medications (acetaminophen, antihistamines, anti-infectives, asthma/COPD medications, etc.), 2) Process 90-day prescription supplies when prescribed, 3) Bill cough and cold medications for adults over 21, 4) Apply prior authorization for hydroxychloroquine exceeding 4 tablets/day or 10-day supply, 5) Use brand name albuterol products when generics unavailable due to shortages. Pharmacies must refund copayments collected March 1-April 21, 2020 for covered COVID medications and resubmit claims.