MedicaidPrior AuthMedium impact
MAB2025111406
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Gastroenterology·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for Thrombopoietics (platelet-boosting medications) effective January 5, 2026. The key change expands coverage to include uses supported by the NCCN Drugs & Biologics Compendium when platelet counts are not less than 30 x 10⁹/L, broadening the clinical scenarios where these medications can be approved.
Action Required
By January 5, 2026: Billing and prior authorization staff must update Medicaid prior authorization procedures for Thrombopoietics to include the new NCCN Compendium coverage criteria. Ensure prescribers are aware that Thrombopoietics can now be approved for NCCN-supported indications even when platelet counts are ≥30 x 10⁹/L. Update prior authorization request templates to include NCCN Compendium references when applicable. All Thrombopoietic prescriptions still require prior authorization from appropriate specialists.