MedicaidPrior AuthMedium impact
MAB2024111302
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Cardiology, Rheumatology +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for oral and inhaled pulmonary hypertension medications, adding new guidelines for renewal requests of non-preferred drugs when therapeutically equivalent preferred options are available on the Preferred Drug List.
Action Required
By January 6, 2025: Pharmacy and prescribing staff must review updated prior authorization requirements for pulmonary hypertension agents (oral and inhaled). Update prior authorization workflows to include new renewal guidelines for non-preferred agents when therapeutically equivalent preferred alternatives exist on PA Preferred Drug List. Ensure all prescribers are aware that non-preferred agents now require documentation of failure, contraindication, or intolerance to preferred agents, or current history of use within past 90 days.