MedicaidPrior AuthLow impact
MAB2024111206
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pharmacy, Pediatrics·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for pancreatic enzymes, clarifying that non-preferred brands and generics will be evaluated considering therapeutically equivalent alternatives. The updated guidelines take effect January 6, 2025.
Action Required
Before January 6, 2025: Billing team should review the updated Pennsylvania Medical Assistance Preferred Drug List for pancreatic enzymes at papdl.com. Ensure pharmacy staff understand that prior authorization is required for non-preferred pancreatic enzymes and that therapeutic equivalency will be considered in approval decisions. Update prior authorization request procedures to include documentation of therapeutic failure, contraindications, or recent history of non-preferred enzyme use.