MedicaidPrior AuthLow impact
MAB2024111206
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pharmacy, General Practice +3 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated prior authorization requirements for non-preferred pancreatic enzymes, adding consideration of therapeutically equivalent brands and generics when evaluating requests. The updated guidelines allow approval if patients have therapeutic failure, contraindication, intolerance to preferred enzymes, or recent history (within 90 days) of the same non-preferred enzyme.
Action Required
Before January 6, 2025: Pharmacy and prescribing staff must review updated Pennsylvania Medical Assistance prior authorization guidelines for pancreatic enzymes. Update prior authorization request procedures to include documentation of therapeutic failure, contraindications, or intolerance to preferred enzymes when requesting non-preferred pancreatic enzyme prescriptions. Refer to the updated Preferred Drug List at papdl.com for current preferred options.