MedicaidPrior AuthLow impact
MAB2025111005
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Cardiology +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is implementing updated prior authorization requirements for lipotropic and statin medications, including new guidelines for combination products containing multiple active ingredients. The changes affect both fee-for-service and managed care delivery systems.
Action Required
Before January 5, 2026: Review updated prior authorization guidelines for lipotropic and statin prescriptions. Ensure prescribers understand new requirements for non-preferred combination products and document clinical reasons when individual active ingredients cannot be used concurrently. Update prior authorization request procedures to include required medical necessity documentation per the revised handbook guidelines.