MedicaidPrior AuthMedium impact
mab2025120201
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is restructuring their Preferred Drug List effective January 1, 2026, creating a new GLP-1 Receptor Agonists therapeutic class and requiring prior authorization for previously preferred DPP-4 inhibitors. This affects pharmacy billing and prior authorization requirements for diabetes and obesity medications.
Action Required
By January 1, 2026: Billing and clinical teams must update prior authorization workflows for GLP-1 receptor agonists moved to the new therapeutic class and begin obtaining prior authorization for all DPP-4 inhibitors (previously preferred drugs that now require PA). Monitor for separate MA Bulletins with specific prior authorization guidelines. Update EMR templates to prompt for medical necessity documentation for affected diabetes and obesity medications.