MedicaidPrior AuthMedium impact
MAB2024111201
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Colony Stimulating Factors (medications used to boost white blood cell counts, commonly in cancer treatment). New guidelines require prescriptions to be by specialists, follow specific dosing protocols, and include stricter medical necessity criteria including risk factor documentation for febrile neutropenia prevention.
Action Required
By January 6, 2025: Billing team must update prior authorization processes for all Colony Stimulating Factor prescriptions for Pennsylvania Medicaid patients. Ensure prescribers document: specialist consultation/prescription, FDA-approved dosing, risk factors for febrile neutropenia per NCCN guidelines, and trial/failure of preferred products before non-preferred ones. Update PA request forms to include these new requirements. Claims without proper prior authorization will be denied.