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 Medicaid is reorganizing diabetes medication prior authorization requirements effective January 1, 2026. DPP-4 inhibitors will have their own therapeutic class with updated prior authorization criteria, while GLP-1 receptor agonists will be moved to a separate new class.
Action Required
Before January 1, 2026: Billing and clinical staff must update prior authorization procedures for Pennsylvania Medicaid patients receiving DPP-4 inhibitors. Ensure documentation shows therapeutic failure, contraindication, or intolerance to metformin before prescribing any DPP-4 inhibitor. For non-preferred DPP-4 inhibitors, document failure of preferred options first. Update EMR templates to capture required clinical justification. Review the updated Preferred Drug List at papdl.com to identify which DPP-4 inhibitors are preferred versus non-preferred.