MedicaidPrior AuthMedium impact
MAB2025111305
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Nephrology, Gastroenterology +5 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 oral glucocorticoids, including specific guidelines for eosinophilic esophagitis and primary immunoglobulin A nephropathy treatment. Non-preferred oral glucocorticoids and quantities exceeding limits will require prior authorization with documented medical necessity.
Action Required
Before January 5, 2026: Billing team must update prior authorization processes for oral glucocorticoid prescriptions in Pennsylvania Medicaid cases. Providers must document therapeutic failure of preferred drugs, contraindications, or intolerances when prescribing non-preferred oral glucocorticoids. For eosinophilic esophagitis cases, document trial of inhaled fluticasone propionate. For primary IgAN cases, ensure nephrologist consultation and kidney biopsy confirmation are documented. Update encounter forms to capture required clinical documentation to avoid claim denials.