MedicaidPrior AuthMedium impact
MAB2025111304
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Allergy & Immunology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for inhaled glucocorticoids (steroid inhalers) effective January 5, 2026. Non-preferred inhaled steroids, quantities exceeding limits, and therapeutic duplications will require prior authorization with specific medical necessity documentation.
Action Required
Before January 5, 2026: Billing team must update systems to flag Pennsylvania Medicaid patients receiving non-preferred inhaled glucocorticoids for prior authorization requirements. Providers must document therapeutic failure, contraindications, or intolerance to preferred agents before prescribing non-preferred inhaled steroids. Front desk staff should verify preferred drug list status at https://papdl.com/preferred-drug-list before scheduling inhaled steroid prescriptions. Claims without proper prior authorization will be denied.