MedicaidPrior AuthMedium impact
MAB2025112401
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is restructuring diabetes medication prior authorization requirements effective January 1, 2026. DPP-4 inhibitors will be separated into their own therapeutic class with specific prior authorization criteria, while GLP-1 receptor agonists will move to a new separate class.
Action Required
Before January 1, 2026: Update prior authorization workflows for Pennsylvania Medicaid patients prescribed DPP-4 inhibitors. Ensure documentation shows metformin failure/contraindication/intolerance AND preferred drug trial failure for non-preferred agents. Add alerts for therapeutic duplication checks between DPP-4 inhibitors and GLP-1 receptor agonists. Train staff on new drug class classifications.