MedicaidPrior AuthMedium impact
MAB2024111202
Pennsylvania Medicaid (DHS)·PA · Dermatology, Allergy & Immunology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new and updated prior authorization requirements for immunomodulators used to treat atopic dermatitis, including specific guidelines for topical PDE4 inhibitors, topical JAK inhibitors, and targeted systemic immunomodulators. The policy establishes step therapy requirements and documentation criteria for medical necessity determinations.
Action Required
By January 6, 2025: Billing and clinical teams must implement new prior authorization procedures for immunomodulators used in atopic dermatitis treatment for Pennsylvania Medicaid patients. Update billing system flags to require prior auth for non-preferred immunomodulators, topical PDE4 inhibitors, topical JAK inhibitors, and targeted systemic immunomodulators. Ensure providers document step therapy trials (4-week topical corticosteroid, 8-week topical calcineurin inhibitor) and specialist consultation requirements for systemic treatments. Claims without proper prior authorization will be denied.