MedicaidPrior AuthMedium impact
MAB2023110704
Pennsylvania Medicaid (DHS)·PA · Dermatology, Pulmonology, Allergy & Immunology +2 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Dupixent (dupilumab) effective January 8, 2024. The policy adds new restrictions preventing concurrent use with other targeted immunomodulators for atopic dermatitis, revises guidelines for moderate to severe atopic dermatitis treatment, and adds coverage criteria for the newly FDA-approved indication of prurigo nodularis.
Action Required
By January 8, 2024: Providers prescribing Dupixent must ensure prior authorization requests comply with updated guidelines. Verify patients discontinue other targeted immunomodulators (Adbry, Cibinqo, Rinvoq) before starting Dupixent for atopic dermatitis. Update prior authorization forms to include prurigo nodularis criteria requiring 6+ weeks of pruritis and either ≥20 nodular lesions or significant functional impairment. Coordinate with dermatology, pulmonology, allergy/immunology, and other appropriate specialists for proper authorization requests.