MedicaidPrior AuthMedium impact
MAB2025111001
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for topical antipsoriatic medications, including specific guidelines for newer drug classes like topical AhR agonists and PDE4 inhibitors. The policy also adds quantity limits and requires step therapy with preferred medications before non-preferred options can be approved.
Action Required
By January 5, 2026: Billing and clinical teams must update prior authorization workflows for Pennsylvania Medicaid patients receiving topical antipsoriatic medications. Staff must verify preferred drug status, check quantity limits, and ensure step therapy documentation is complete for non-preferred medications including tapinarof and roflumilast. Update EMR templates to capture required trial history and contraindication documentation. Claims for non-preferred antipsoriatics will be denied without proper prior authorization.