MedicaidPrior AuthMedium impact
MAB2025110601
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Rheumatology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for bone density regulators (osteoporosis medications) effective January 5, 2026. New requirements include prior auth for preferred bone-modifying monoclonal antibodies and updated medical necessity guidelines for non-preferred drugs with preferred alternatives.
Action Required
By January 5, 2026: Billing team must update prior authorization workflows for Pennsylvania Medicaid bone density regulator prescriptions. Ensure pharmacy staff know that preferred bone-modifying monoclonal antibodies now require prior auth. Update documentation requirements to include evaluation for secondary causes of osteoporosis (CBC, vitamin D, calcium, phosphorus, etc.) and specific criteria for anabolic agents. Review Preferred Drug List at papdl.com for current preferred medications. Claims without proper prior authorization will be denied.