MedicaidPrior AuthMedium impact
MAB2025110704
Pennsylvania Medicaid (DHS)·PA · Hematology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for antihemophilia agents effective January 5, 2026. Key changes include deletion of specific Hemlibra guidelines, addition of non-factor replacement agent guidelines, and new quantity limit requirements for all antihemophilia medications.
Action Required
Before January 5, 2026: Pharmacy and billing teams must update prior authorization procedures for antihemophilia agents. Review updated guidelines requiring prescriptions from hematologists or hemophilia treatment centers, implement new non-factor replacement agent criteria, and ensure all antihemophilia agents follow quantity limit guidelines. Update system to flag bypassing agents requiring emicizumab trial documentation for hemophilia A with inhibitors.