MedicaidPrior AuthMedium impact
MAB2023110703
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Hematology, Dermatology +1 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing revised prior authorization guidelines for Hereditary Angioedema (HAE) agents effective January 8, 2024. Key changes include updated criteria for HAE Type III diagnosis and new requirements for non-preferred HAE agents to consider therapeutically equivalent generics and biosimilars.
Action Required
By January 8, 2024: Billing and pharmacy teams must update prior authorization processes for all HAE agents for Pennsylvania Medicaid patients. Ensure prescribers are aware that HAE Type III patients with genetic mutations no longer need to fail antihistamine therapy, and non-preferred HAE agents now require consideration of therapeutically equivalent alternatives. Update prior authorization request forms to include new documentation requirements. Claims without proper prior authorization will be denied.