MedicaidPrior AuthMedium impact
MAB2023110702
Pennsylvania Medicaid (DHS)·PA · Hematology, Pharmacy·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for Antihemophilia Agents effective January 8, 2024. The key change clarifies that Hemlibra (emicizumab) is now approved for congenital hemophilia A treatment, with specific guidelines for when it must be tried before bypassing agents for routine prophylaxis.
Action Required
By January 8, 2024: Billing and clinical teams must update prior authorization procedures for Antihemophilia Agents for Pennsylvania Medicaid patients. Ensure prescribers are aware that Hemlibra (emicizumab) must be documented as failed, contraindicated, or medically inappropriate before approving bypassing agents (FEIBA, NovoSeven RT, Sevenfact) for routine prophylaxis in hemophilia A patients with inhibitors. Update clinical documentation templates to capture required medical necessity criteria including prescriber specialty (hematologist or hemophilia treatment center), FDA-approved indications, and failure/contraindication documentation for non-preferred agents.