MedicaidPrior AuthLow impact
MAB2024110605
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Hematology, Dermatology +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for Hereditary Angioedema (HAE) agents, adding new guidelines for renewal requests of non-preferred HAE medications. All HAE agents continue to require prior authorization with specific clinical criteria.
Action Required
By January 6, 2025: Billing and pharmacy staff must ensure all HAE agent prescriptions have prior authorization through Pennsylvania Medicaid. Update prior authorization request procedures to include new renewal guidelines for non-preferred HAE agents, requiring documentation of therapeutic failure or contraindication to preferred agents. Claims without proper prior authorization will be denied.