MedicaidPrior AuthLow impact
MAB2024110605
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Hematology, Dermatology +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Hereditary Angioedema (HAE) agents, adding new guidelines specifically for renewal requests of non-preferred HAE agents. All HAE agents continue to require prior authorization with detailed clinical criteria.
Action Required
By January 6, 2025: Billing team should review updated prior authorization guidelines for HAE agents in Pennsylvania Medicaid. Ensure providers prescribing HAE agents are aware of the new renewal criteria for non-preferred agents, including requirements for therapeutic failure or contraindication documentation. Update any internal prior authorization checklists to reflect the revised renewal guidelines.