MedicaidPrior AuthMedium impact
MAB2024111401
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Gastroenterology +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Thrombopoietics (medications that increase platelet production) effective January 6, 2025. The changes add new guidelines for severe aplastic anemia treatment and remove certain previous requirements, affecting prescribers and pharmacies serving Medicaid patients.
Action Required
By January 6, 2025: Prescribers treating Pennsylvania Medicaid patients with Thrombopoietics must update prior authorization requests to include new severe aplastic anemia criteria (marrow cellularity <25% plus two of three specific lab values). Remove references to diarrhea monitoring for Tavalisse renewals. Ensure all Thrombopoietic prescriptions include consultation with appropriate specialists (hematologist/oncologist, gastroenterologist, hepatologist). Update EMR templates to capture required baseline lab results and monitoring documentation per FDA labeling.