MedicaidPrior AuthMedium impact
MAB2023112702
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for ulcerative colitis medications, adding new S1PR modulator drugs (Velsipity/etrasimod) to existing guidelines and consolidating Zeposia authorization rules. All S1PR modulators now require prior authorization with specific clinical criteria.
Action Required
By January 8, 2024: Pharmacy and prescribing staff must update prior authorization processes for ulcerative colitis medications. Ensure all S1PR modulators (including new drug Velsipity/etrasimod) require prior auth with documentation of specialist consultation, appropriate diagnosis, failed conventional therapy, and specific clinical criteria. Update system to reference new consolidated Ulcerative Colitis Agents guidelines instead of separate Zeposia bulletin. Claims without proper prior authorization will be denied.