MedicaidPrior AuthMedium impact
MAB2023122101
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for diabetes and obesity medications, specifically adding new guidelines for GLP-1 receptor agonists used for obesity treatment. The policy requires prior authorization for non-preferred drugs, quantity limit overrides, and therapeutic duplications in this drug class.
Action Required
By January 8, 2024: Billing and clinical teams must update prior authorization procedures for hypoglycemic and incretin mimetic/enhancer medications for Pennsylvania Medicaid patients. Providers must document BMI criteria, weight-related comorbidities, lifestyle counseling, and therapeutic failures for GLP-1 receptor agonists prescribed for obesity. Update EMR templates to capture required documentation elements. Claims may be denied without proper prior authorization.