MAB2025111201

Before January 5, 2026: Update billing workflows to identify PPI prescriptions requiring prior authorization including non-preferred PPIs, quantities exceeding limits, pediatric patients under 6 years with 4+ months use in 180 days, OTC PPIs for dual-eligible beneficiaries, and therapeutic duplications. Train clinical staff on new medical necessity documentation requirements including FDA-approved indications, appropriate dosing/duration, and contraindication/failure history for preferred options. Update prior authorization request procedures per handbook Section I requirements to prevent claim denials.