MedicaidPrior AuthMedium impact
MAB2025111404
Pennsylvania Medicaid (DHS)·PA · Cardiology, Endocrinology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for lipotropic medications (cholesterol-lowering drugs) including PCSK9 inhibitors, ACL inhibitors, and other specialized lipid medications. Pharmacies and prescribers must obtain prior authorization for these medications starting January 5, 2026.
Action Required
By January 5, 2026: Providers prescribing lipotropic medications (PCSK9 inhibitors like alirocumab/evolocumab, bempedoic acid, lomitapide, evinacumab, olezarsen) to Pennsylvania Medicaid patients must obtain prior authorization before prescribing. Update EMR templates to include required documentation: lipid profile results within 3 months, statin trial history, and medical necessity criteria. Train clinical staff on new prior auth process using the Fee-for-Service Provider Service Center (1-800-537-8862). Prescriptions without prior auth will be denied by pharmacy.