MedicaidPrior AuthLow impact
MAB2024111306
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization guidelines for thalidomide and derivatives effective January 6, 2025. The main changes include considering therapeutically equivalent brands/generics when evaluating non-preferred drugs and removing tolerability requirements from renewal requests.
Action Required
By January 6, 2025: Billing team should review updated prior authorization requirements for thalidomide and derivatives for Pennsylvania Medicaid patients. Ensure prescribers are aware that non-preferred drugs now require documentation of failure/contraindication to therapeutically equivalent preferred options, and tolerability is no longer required for renewals. Update internal protocols to reflect these changes.