MedicaidPrior AuthMedium impact
mab2024110602
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pediatrics, Internal Medicine·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for Hepatic and Biliary Agents (formerly Bile Salts), including new requirements for PPAR agonist drugs like elafibranor. The policy requires specialist prescribing and specific documentation for drugs like cholic acid, obeticholic acid, and PPAR agonists.
Action Required
By January 6, 2025: Billing team must update prior authorization processes for Hepatic and Biliary Agents in Pennsylvania Medicaid. Ensure providers know that cholic acid, obeticholic acid, and PPAR agonist drugs (e.g., elafibranor) require prior authorization with specialist prescribing (hepatologist, gastroenterologist, or pediatric gastroenterologist) and documented lab results. Update encounter forms to remind providers of these requirements. Claims without proper prior authorization will be denied.