MedicaidPrior AuthMedium impact
MAB2023110802
Pennsylvania Medicaid (DHS)·PA · Ophthalmology·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for macular degeneration agents effective January 8, 2024. New guidelines add coverage for Syfovre (pegcetacoplan) and establish specific renewal criteria for non-preferred agents.
Action Required
By January 8, 2024: Ophthalmology and retinal specialist practices must update prior authorization processes for macular degeneration agents. Ensure prescribers document FDA-approved indications, therapeutic failure/contraindication to bevacizumab, and positive clinical response for renewals. Update billing workflows to verify retinal specialist prescriber requirement and check preferred drug list status before submitting claims.