MedicaidPrior AuthMedium impact
MAB2024111401
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Gastroenterology +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for Thrombopoietics (medications that increase platelet count) effective January 6, 2025. The updated guidelines add coverage for severe aplastic anemia treatment and remove certain renewal requirements, requiring specialist consultation and specific lab values for approval.
Action Required
By January 6, 2025: Billing team must update prior authorization processes for all Thrombopoietic medications for Pennsylvania Medicaid patients. Ensure providers obtain specialist consultation (hematologist/oncologist, gastroenterologist, or hepatologist) before prescribing. Update documentation requirements to include baseline lab results, platelet counts, and specific criteria based on indication (thrombocytopenia <50x10⁹/L for procedures, <30x10⁹/L for other indications, or severe aplastic anemia criteria). Claims without proper prior authorization will be denied.