MedicaidPrior AuthMedium impact
MAB2023110603
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Infectious Disease +2 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for CMV antiviral medications, specifically adding new requirements for letermovir (Prevymis) following FDA approval for kidney transplant recipients. All prescriptions for letermovir will now require prior authorization regardless of preferred status.
Action Required
By January 8, 2024: Billing and pharmacy teams must update prior authorization workflows to require PA for all letermovir prescriptions for Pennsylvania Medicaid patients. Providers must prescribe letermovir only in consultation with specialists (hematologist/oncologist, infectious disease, or transplant specialist) and document CMV-seropositive status or high risk for CMV reactivation. Update encounter forms and EMR templates to include specialist consultation documentation requirements.