MedicaidPrior AuthMedium impact
MAB2025111701
Pennsylvania Medicaid (DHS)·PA · Ophthalmology, Optometry, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for non-preferred dry eye treatments effective January 5, 2026. Prescribers must now demonstrate therapeutic failure, contraindication, or intolerance to preferred treatments AND justify the anticipated duration of treatment before prescribing non-preferred dry eye medications.
Action Required
By January 5, 2026: Providers prescribing dry eye treatments to Pennsylvania Medicaid patients must update their prior authorization request process to include documentation of therapeutic failure of preferred treatments AND justification for anticipated duration of treatment. Update EMR templates and prior auth workflows to capture this additional clinical information. Pharmacy staff must verify preferred drug list status before dispensing to avoid claim denials.