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Medical Assistance (Medicaid) Formulary Introduction

The Gateway HealthSM Formulary is a list of FDA-approved medications reviewed and approved by our Pharmacy and Therapeutics (P&T) Committee and the Department of Public Welfare (DPW).  The Pharmacy and Therapeutics Committee is comprised of actively participating network physicians and pharmacists who select products on the basis of their safety, efficacy, quality and cost to the plan.

Physicians are requested to prescribe medications included in the formulary whenever medically appropriate.  All drugs in the formulary are not necessarily covered by each patient’s prescription drug coverage.  Providers can contact provider/pharmacy services for any questions related to a member’s prescription coverage limitations.

The drug formulary is divided into major therapeutic categories (chapters) for easy use.  Products that are approved for more than one therapeutic indication may be included in more than one chapter.  Drugs are listed by generic names; brand names are specified for reference.

The P&T Committee meets on a quarterly basis to review and revise the formulary.  All providers (both participating pharmacies and physicians) are provided copies of the Gateway HealthSM formulary and are periodically notified of formulary updates.

Providers may request addition of a medication to the formulary.  Requests must include the drug name, rationale for inclusion on the formulary, role in therapy and formulary medications that may be replaced by the addition. The committee will review requests.

Forward all requests in writing to:

Gateway HealthSM
Pharmacy Department
Four Gateway Center
444 Liberty Avenue, Suite 2100
Pittsburgh, PA 15222-1222

Questions about the formulary and its use can be directed to the Pharmacy Service Center at 1-800-392-1147.