MedicaidPrior AuthMedium impact
MAB2025111205
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization guidelines for COPD medications to include approval criteria for Dupixent (dupilumab) for COPD treatment. The policy also maintains existing requirements for other COPD agents including therapeutic duplication checks and quantity limits.
Action Required
By January 5, 2026: Pharmacy and prescribing staff must review updated prior authorization requirements for COPD agents, particularly new Dupixent (dupilumab) criteria. Update prior authorization request processes to include proper documentation for medical necessity determination. Ensure therapeutic duplication checks are in place for inhaled glucocorticoids, long-acting anticholinergics, and long-acting beta agonists.