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 (GLP-1 drugs like Ozempic, Wegovy) effective September 2, 2024. Key changes include expanded coverage criteria for cardiovascular disease patients and new step therapy requirements for diabetic patients who must try diabetes-specific GLP-1 drugs first.
Action Required
By September 2, 2024: Update prior authorization procedures for obesity treatment agents containing GLP-1 receptor agonists. Staff must verify patients with diabetes have tried preferred diabetes GLP-1 drugs before requesting obesity-specific versions. Add cardiovascular disease to accepted weight-related comorbidities list. Update PA request forms to include new documentation requirements for therapeutic failures and contraindications.