MedicaidPrior AuthMedium impact
MAB2025111001
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, General Practice +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 topical antipsoriatic medications, including quantity limits and specific guidelines for newer drug classes like topical AhR agonists and PDE4 inhibitors. Providers must document therapeutic failures of first-line treatments before prescribing these medications.
Action Required
By January 5, 2026: Update prior authorization protocols for Pennsylvania Medicaid patients receiving topical antipsoriatic medications. Billing team must verify preferred drug status on PA PDL before prescribing non-preferred options. Providers must document therapeutic failures of topical corticosteroids and first-line treatments for tapinarof and roflumilast prescriptions. Update EMR templates to capture required medical necessity documentation including contraindications, intolerances, and treatment history. Claims will be denied without proper prior authorization.