MedicaidPrior AuthMedium impact
mab2024110803
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Pulmonology, Dermatology +3 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for monoclonal antibodies (MABs) targeting Anti-IL, Anti-IgE, and Anti-TSLP pathways. The key change allows consideration of therapeutically equivalent interchangeable biosimilars when evaluating requests for non-preferred MABs, potentially expanding coverage options.
Action Required
By January 6, 2025: Review current MABs prescriptions and prior authorization processes for drugs like Dupixent, Xolair, Cinqair, and Nucala. Update prior authorization request procedures to include biosimilar equivalency documentation when requesting non-preferred MABs. Ensure all MABs prescriptions have proper specialist consultation documentation and meet the detailed medical necessity criteria outlined in the policy. Train staff on the updated interchangeable biosimilar provisions for non-preferred requests.