MedicaidPrior AuthMedium impact
MAB2024111204
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania's Medical Assistance program is updating prior authorization requirements for Natalizumab (used for multiple sclerosis and Crohn's disease) effective January 6, 2025. Key changes include requiring FDA-approved dosing, specialist prescriber verification, and enhanced guidelines for non-preferred products during renewal requests.
Action Required
By January 6, 2025: Billing team must update prior authorization workflows for Natalizumab prescriptions to ensure documentation includes: FDA-approved dosing verification, specialist prescriber confirmation (neurologist for MS, gastroenterologist for Crohn's), and enhanced justification for non-preferred products. Update PA request forms and staff training materials. Claims without proper documentation will be denied.