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 Medicaid updated prior authorization requirements for obesity treatment agents including GLP-1 receptor agonists, expanding coverage criteria to include cardiovascular disease as a comorbidity and adding new approval pathways for patients with diabetes history. The changes also updated language to cover newer combination drugs containing GLP-1 receptor agonists.
Action Required
By September 2, 2024: Billing and clinical teams must update prior authorization procedures for obesity treatment agents. Update EMR templates to document new requirements including cardiovascular disease as qualifying comorbidity, history of diabetes/antidiabetic drugs in last 120 days, and therapeutic failure of preferred GLP-1 drugs. Train providers on expanded approval criteria for combination GLP-1 drugs. Failure to meet new documentation requirements will result in prior authorization denials for obesity medications.