MedicaidPrior AuthMedium impact
MAB2025110705
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Allergy & Immunology, Dermatology +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Effective January 5, 2026, all Pennsylvania Medicaid prescriptions for Monoclonal Antibodies (Anti-IL, Anti-IgE, Anti-TSLP) will require prior authorization with updated medical necessity guidelines. The policy clarifies requirements for non-preferred MABs and establishes specific criteria for various conditions including asthma, chronic spontaneous urticaria, EGPA, and hypereosinophilic syndrome.
Action Required
Before January 5, 2026: Billing and clinical staff must update workflows to ensure all Pennsylvania Medicaid patients requiring MAB prescriptions (Anti-IL, Anti-IgE, Anti-TSLP) have prior authorization obtained before dispensing. Providers must verify prescriptions meet the specific medical necessity criteria including appropriate specialist consultation, proper dosing, and condition-specific requirements. Update EMR alerts and pharmacy systems to flag these medications for PA requirements.