MedicaidPrior AuthMedium impact
MAB2023110903
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Natalizumab (formerly Tysabri) for multiple sclerosis and Crohn's disease treatment. The policy title changes but clinical requirements remain the same, requiring specialist consultation and documentation of treatment failures for specific conditions.
Action Required
By January 8, 2024: Billing and clinical teams must ensure all Natalizumab prescriptions have prior authorization before dispensing. Verify that prescriptions are written by or in consultation with neurologists (for MS) or gastroenterologists (for Crohn's disease). Update billing system notes to reference updated Natalizumab guidelines instead of Tysabri guidelines. Claims without proper prior authorization will be denied.