MedicaidCoverageLow impact
OMAP MAB 99-0407 Revised List of Nutritional Supplements
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Pharmacy·Provider Bulletin
Effective date
Apr 12, 2004
We identified it
Jun 20, 2026
Summary
Pennsylvania's Special Pharmaceutical Benefits Program (SPBP) for HIV/AIDS updated its formulary list of covered nutritional supplements (Tier 4, Priority 13), removing discontinued products, correcting product names, and adding previously omitted supplements. This affects billing for nutritional supplements prescribed to SPBP HIV/AIDS patients with identification cards beginning with SP1.
Action Required
Immediately: Billing team must obtain the updated Attachment A list of covered nutritional supplements for SPBP HIV/AIDS patients. Update billing system with current formulary list effective April 12, 2004. Verify patient eligibility using SPBP ID cards beginning with SP1. Continue billing third-party insurance first before submitting SPBP claims using appropriate NDC codes through First Health Services Corporation.