MedicaidPrior AuthMedium impact
mab2024110802
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Rheumatology·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization guidelines for Antifibrotic Respiratory Agents effective January 6, 2025. The main change is that therapeutic equivalent brands and generics will now be considered when evaluating requests for non-preferred medications in this drug class.
Action Required
By January 6, 2025: Billing and clinical teams must update prior authorization procedures for Antifibrotic Respiratory Agents for Pennsylvania Medicaid patients. Ensure prescribers are aware that non-preferred brands/generics now require documentation of failure, contraindication, or intolerance to therapeutically equivalent preferred options. Update prior auth request forms to include this new requirement. Claims may be delayed or denied without proper documentation.