MedicaidPrior AuthHigh impact
MAB2024080701
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 Medicaid now requires prior authorization for ALL GLP-1 receptor agonist medications (including preferred drugs) used for diabetes and weight management, with specific medical necessity criteria for each indication. Previously only non-preferred drugs in this class required prior auth.
Action Required
By September 2, 2024: Update prior authorization workflows to obtain approval for ALL GLP-1 receptor agonist prescriptions (semaglutide, liraglutide, etc.) for Pennsylvania Medicaid patients, regardless of preferred status. Train staff on new medical necessity requirements: diabetes patients need diabetes diagnosis or recent antidiabetic drug history; obesity/overweight patients need BMI criteria, lifestyle counseling documentation, and age-appropriate usage per FDA labeling. Update EMR templates to capture required documentation elements.