MedicaidPrior AuthMedium impact
MAB2023112701
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding prior authorization requirements for two multiple sclerosis drugs (Kesimpta and Ocrevus) that are moving to preferred status, and updating guidelines for non-preferred MS agents to consider generic/biosimilar alternatives.
Action Required
By January 8, 2024: Billing and pharmacy teams must update prior authorization workflows to include Kesimpta (ofatumumab) and Ocrevus (ocrelizumab) for Pennsylvania Medicaid patients, even though these drugs are moving to preferred status. Update systems to require neurologist prescriptions for MS agents and ensure proper documentation of medical necessity criteria. Review non-preferred MS agent requests to consider therapeutically equivalent generics, biosimilars, and unbranded biologics first.