All Insurance Policy Changes (Page 388)

Continuing from page 387. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
mab2024110806
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for all Botulinum Toxin prescriptions effective January 6, 2025. Key changes include revised guidelines for chronic spasticity (removing oral drug trial requirements for focal spasticity and pediatric patients), addition of CGRP therapies as acceptable prior treatments for chronic migraine, and new renewal documentation requirements including injection site mapping.
Medium impact
MAB2024111202
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for immunomodulators used to treat atopic dermatitis, including specific guidelines for topical PDE4 inhibitors, topical JAK inhibitors, and targeted systemic immunomodulators. The policy establishes step therapy requirements and documentation criteria that must be met before approval.
Medium impact
MAB2024111201
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for Colony Stimulating Factors (medications used to boost white blood cell counts, commonly in cancer treatment). New guidelines require prescriptions to be by specialists, follow specific dosing protocols, and include stricter medical necessity criteria including risk factor documentation for febrile neutropenia prevention.
Medium impact
MAB2024111204
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for Natalizumab (used for multiple sclerosis and Crohn's disease) effective January 6, 2025. New renewal criteria require FDA-approved dosing, specialist prescribing, and specific guidelines for non-preferred products.
Medium impact
MAB2024111205
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for oral oncology agents, effective January 6, 2025. The main changes include new requirements to consider therapeutically equivalent brands/generics when evaluating non-preferred drugs, and removal of tolerability guidelines from renewal requests.
Low impact
MAB2024111206
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for pancreatic enzymes, clarifying that non-preferred brands and generics will be evaluated considering therapeutically equivalent alternatives. The updated guidelines take effect January 6, 2025.
Medium impact
mab2024111203
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for lipotropic medications (cholesterol drugs) effective January 6, 2025. The policy removes some previous guidelines for PCSK9 inhibitors and ACL inhibitors while maintaining requirements for prior authorization of non-preferred drugs, quantity limit exceeds, and specific drug classes.
Low impact
MAB2024111301
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is changing the name of 'Phosphate Binders' to 'Phosphate Lowering Agents' in their preferred drug list therapeutic class, effective January 6, 2025. No changes to prior authorization requirements or medical necessity guidelines - this is purely a terminology update.
Medium impact
MAB2024111302
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for oral and inhaled pulmonary hypertension medications, adding new guidelines for renewal requests of non-preferred drugs when therapeutically equivalent preferred options are available on the Preferred Drug List.
Low impact
MAB2024111303
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is removing the requirement for prescribers to document searches of the Prescription Drug Monitoring Program when requesting prior authorization for skeletal muscle relaxants. All other prior authorization requirements for these medications remain unchanged.
Medium impact
MAB2024111304
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania's Statewide Preferred Drug List (PDL) will be updated effective January 6, 2025, changing preferred and non-preferred status of medications, adding new quantity limits, and updating prior authorization guidelines. This affects all Pennsylvania Medical Assistance providers including pharmacies and prescribers.
Medium impact
MAB2024111305
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for stimulants and related agents effective January 6, 2025. Key changes include revised guidelines for non-preferred stimulants to consider therapeutically equivalent alternatives, removal of prescription drug monitoring program documentation requirements, and updated renewal guidelines for both standard and analeptic stimulant agents.
Low impact
MAB2024111306
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization guidelines for thalidomide and derivatives effective January 6, 2025. The main changes include considering therapeutically equivalent brands/generics when evaluating non-preferred drugs and removing tolerability requirements from renewal requests.
Medium impact
MAB2024111401
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Thrombopoietics (medications that increase platelet production) effective January 6, 2025. The changes add new guidelines for severe aplastic anemia treatment and remove certain previous requirements, affecting prescribers and pharmacies serving Medicaid patients.
Medium impact
MAB2024111402
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is adding new prior authorization requirements for sphingosine 1-phosphate receptor modulators used to treat ulcerative colitis. Providers must obtain prior authorization for all S1PR modulators and meet specific clinical criteria including specialist consultation and step therapy requirements.
Medium impact
MAB2024110706
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for non-opioid barbiturate combination analgesics (like Fiorinal, Fioricet) effective January 6, 2025. The main changes are updated consensus guideline examples and removal of the requirement to document Prescription Drug Monitoring Program searches, but all other strict prior authorization criteria remain.
Medium impact
MAB2024110705
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid has updated prior authorization requirements for long-acting opioid analgesics, creating special exemptions for buprenorphine products that no longer require documentation of short-acting opioid trials or opioid tolerance. All long-acting opioid prescriptions still require prior authorization with extensive clinical documentation including pain assessments, drug screening results, and risk evaluations.
Medium impact
MAB2024110704
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for short-acting opioid analgesics, specifically adding new medical necessity guidelines for nasal butorphanol in migraine treatment. The updated guidelines include specific requirements for prescriber specialization and failed therapy documentation.
Medium impact
mab2024110702
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid has updated prior authorization requirements for non-preferred antidepressants, adding a new renewal guideline requiring documentation of therapeutic failure, contraindication, or intolerance to preferred therapeutically equivalent alternatives. The policy also includes specific criteria for specialized antidepressants like Zulresso, Zurzuvae, and Spravato.
Medium impact
MAB2024110701
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for SSRI antidepressants, effective January 6, 2025. The main change is that therapeutically equivalent brands and generics will now be considered when evaluating requests for non-preferred SSRIs, with no other changes to medical necessity guidelines.
Medium impact
mab2024110802
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization guidelines for Antifibrotic Respiratory Agents effective January 6, 2025. The main change is that therapeutic equivalent brands and generics will now be considered when evaluating requests for non-preferred medications in this drug class.
Medium impact
mab2024110804
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for Antiparkinson's agents effective January 6, 2025. The key change is that therapeutically equivalent brands and generics will now be considered when evaluating requests for non-preferred Antiparkinson's agents, meaning switching between equivalent formulations may require new prior authorization.
Medium impact
mab2024110805
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medicaid is updating prior authorization requirements for antipsychotic medications effective January 6, 2025. The changes add new guidelines for non-preferred antipsychotics with therapeutically equivalent preferred options and specify that prescriptions exceeding quantity limits require prior authorization.
Medium impact
mab2024110806
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for botulinum toxins effective January 6, 2025. Key changes include revised criteria for chronic spasticity (focal spasticity and pediatric patients no longer need to fail oral medications first), addition of CGRP-targeting therapies as acceptable prior treatments for chronic migraine, and new renewal requirements including injection site documentation.
Medium impact
MAB2024111201
Pennsylvania Medicaid (DHS)·Effective Jan 6, 2025
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Colony Stimulating Factors (medications that boost white blood cell production). New guidelines require prescriptions to be written by specialists, follow FDA-approved dosing, and meet specific clinical criteria for approval.

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