MedicaidPrior AuthMedium impact
MAB2024110604
Pennsylvania Medicaid (DHS)·PA · Pharmacy, Neurology·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding Briumvi (ublituximab-xiiy) to the list of Multiple Sclerosis medications requiring prior authorization, removing Ocrevus from certain non-preferred examples, and updating renewal guidelines for non-preferred MS agents. These changes affect pharmacy billing and prior authorization requirements for MS medications.
Action Required
By January 6, 2025: Pharmacy billing teams must update prior authorization systems to require prior auth for Briumvi (ublituximab-xiiy) prescriptions. Update pharmacy management systems to flag this medication for prior authorization before dispensing. Notify prescribing neurologists about the new prior authorization requirement. Claims for Briumvi without prior authorization will be denied.