MedicaidPrior AuthMedium impact
MAB2024111202
Pennsylvania Medicaid (DHS)·PA · Dermatology, Allergy & Immunology, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for immunomodulators used to treat atopic dermatitis, including specific guidelines for topical PDE4 inhibitors, topical JAK inhibitors, and targeted systemic immunomodulators. The policy establishes step therapy requirements and documentation criteria that must be met before approval.
Action Required
Before January 6, 2025: Billing team must update prior authorization workflows for Pennsylvania Medicaid patients prescribed immunomodulators for atopic dermatitis. Providers must document therapeutic failure or contraindications to preferred medications, ensure step therapy requirements are met (4-week topical corticosteroid trial, 8-week topical calcineurin inhibitor trial), and obtain specialist consultation for systemic immunomodulators. Update encounter forms to include required documentation fields. Failure to obtain prior authorization will result in claim denials for non-preferred drugs and those exceeding quantity limits.