MedicaidPrior AuthMedium impact
MAB2024080702
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Sep 2, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for obesity treatment agents including GLP-1 receptor agonist drugs, adding cardiovascular disease as a qualifying comorbidity and requiring failure of preferred diabetes medications before approving certain obesity drugs for diabetic patients.
Action Required
By September 2, 2024: Billing and clinical staff must update prior authorization procedures for obesity treatment agents under PA Medicaid. Update documentation requirements to include cardiovascular disease as a qualifying weight-related comorbidity. For diabetic patients requesting GLP-1 obesity medications, ensure documentation of therapeutic failure or contraindication to preferred diabetes GLP-1 drugs on the Preferred Drug List. Review renewal criteria to include improvement in adiposity, waist circumference, or weight-related comorbidities as acceptable outcomes.