MedicaidPrior AuthMedium impact
MAB2024110601
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Dermatology, Rheumatology +4 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Cytokine and CAM Antagonists (specialty biologic medications) effective January 6, 2025. The changes include revised tuberculosis and hepatitis B testing requirements, updated guidelines for spesolimab, and new requirements for non-preferred medications with therapeutically equivalent alternatives.
Action Required
By January 6, 2025: Billing and clinical teams must update prior authorization procedures for Cytokine and CAM Antagonists for Pennsylvania Medicaid patients. Providers must ensure appropriate specialist consultation (gastroenterologist, dermatologist, rheumatologist, etc.) before prescribing. Update documentation requirements to include tuberculosis and hepatitis B testing results when indicated by FDA labeling. Claims without proper prior authorization will be denied.