MedicaidPrior AuthMedium impact
MAB2023111401
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 updated prior authorization requirements for obesity treatment medications, removing some requirements for pediatric patients and prescription monitoring searches, while clarifying renewal guidelines for patients still undergoing dose titration.
Action Required
By January 8, 2024: Billing and clinical staff must update prior authorization procedures for obesity treatment agents in Pennsylvania Medicaid patients. Remove requirements for BMI documentation in pediatric patients under 95th percentile and prescription drug monitoring searches. Update renewal request procedures to note that response to therapy will not be evaluated during dose titration periods. Review updated handbook pages and modify internal checklists accordingly.