MedicaidPrior AuthLow impact
MAB2024111306
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization guidelines for Thalidomide and Derivatives, effective January 6, 2025. The changes include new requirements to consider therapeutically equivalent brands/generics when evaluating non-preferred drugs and removal of tolerability guidelines for renewals.
Action Required
By January 6, 2025: Pharmacy and prescribing staff should review updated prior authorization guidelines for Thalidomide and Derivatives. Ensure prescribers understand that non-preferred brands/generics now require comparison to therapeutically equivalent preferred options. Update prior authorization request documentation to reflect new criteria. Only affects practices prescribing these specialty oncology/hematology medications to Pennsylvania Medicaid patients.