MedicaidPrior AuthMedium impact
MAB2024110604
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for Multiple Sclerosis medications, adding Briumvi (ublituximab-xiiy) to the list of drugs requiring prior auth and removing Ocrevus from the non-preferred examples list. New guidelines also affect renewal requirements for non-preferred MS agents with therapeutically equivalent alternatives.
Action Required
Before January 6, 2025: Billing and pharmacy staff must update prior authorization protocols to include Briumvi (ublituximab-xiiy) in the list of MS agents requiring prior auth. Update billing system to flag this medication for prior authorization. Review current patients on non-preferred MS agents to ensure compliance with new renewal guidelines for therapeutically equivalent alternatives. Claims for these medications will be denied without proper prior authorization.