MedicaidPrior AuthMedium impact
MAB2024111204
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Natalizumab (used for multiple sclerosis and Crohn's disease) effective January 6, 2025. New renewal criteria require FDA-approved dosing, specialist prescribing, and specific guidelines for non-preferred products.
Action Required
By January 6, 2025: Update prior authorization workflows for Natalizumab prescriptions to ensure renewal requests include documentation of FDA-approved dosing, specialist prescribing (neurologist for MS, gastroenterologist for Crohn's), and justification for non-preferred products. Train staff on new renewal criteria and update PA request templates accordingly.