MedicaidPrior AuthMedium impact
MAB2023110601
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 now requires prior authorization for all Continuous Glucose Monitoring (CGM) products effective January 8, 2024. All prescriptions must be pre-authorized, with preferred products requiring diabetes diagnosis/medication use, and non-preferred products requiring additional failure criteria or pump compatibility.
Action Required
By January 8, 2024: Billing team must update prior authorization procedures for all Continuous Glucose Monitoring products for Pennsylvania Medicaid patients. Ensure prescribers document diabetes diagnosis or antidiabetic medication use within 90 days. For non-preferred CGM products, document therapeutic failure of preferred products or insulin pump compatibility requirements. Approvals are valid for 12 months. Claims without prior authorization will be denied.