MedicaidPrior AuthMedium impact
MAB2025111402
Pennsylvania Medicaid (DHS)·PA · Dermatology·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for dermatologic immunomodulator drugs, expanding coverage to include new drug classes like topical JAK inhibitors, PDE4 inhibitors, and aryl hydrocarbon receptor agonists. The policy renames the therapeutic class from 'Atopic Dermatitis' to 'Dermatologics' and adds specific step therapy requirements for these specialized topical medications.
Action Required
By January 5, 2026: Billing and prior authorization teams must update procedures to require prior authorization for all topical JAK inhibitors (ruxolitinib, delgocitinib), topical PDE4 inhibitors (crisaborole, roflumilast), topical aryl hydrocarbon receptor agonists (tapinarof), and targeted systemic immunomodulators for dermatologic conditions. Update prior auth request workflows to document required step therapy trials including 4-week topical corticosteroid and 8-week topical calcineurin inhibitor trials for atopic dermatitis and chronic hand eczema indications. Train staff on new medical necessity criteria and failure to obtain required prior authorization will result in claim denials.