MedicaidPrior AuthMedium impact
MAB2025111003
Pennsylvania Medicaid (DHS)·PA · Neurology, PM&R (Physical Medicine & Rehab)·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing updated prior authorization requirements for Multiple Sclerosis agents, including new requirements for Ocrevus Zunovo and revised guidelines for non-preferred MS drugs. The policy affects prescriptions that require prior authorization and changes renewal criteria for certain MS medications.
Action Required
Before January 5, 2026: Billing team must update prior authorization workflows for Multiple Sclerosis agents to include new requirement for Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq). Update system to reflect revised guidelines for non-preferred MS agents requiring documentation of therapeutic failure or contraindication to preferred agents. Verify prescriber specialty requirements (neurologist for most MS agents, neurologist or PM&R for Ampyra). Claims without proper prior authorization will be denied.