MedicaidPrior AuthMedium impact
MAB2023062801
Pennsylvania Medicaid (DHS)·PA · Neurology, Psychiatry, Geriatrics +1 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Amyloid-Targeted Monoclonal Antibodies (MABs), expanding coverage from just Aduhelm to all MABs including new drug Leqembi, and adding cerebrospinal fluid biomarker testing as an alternative to PET scans. The policy includes specific cognitive assessment requirements and contraindication criteria for each medication.
Action Required
By July 10, 2023: Billing team must update prior authorization workflows for all Amyloid-Targeted MABs in Pennsylvania Medicaid. Ensure prescribers are dementia specialists and patients have required baseline MRI, beta-amyloid testing (PET scan or CSF biomarker), and meet drug-specific cognitive assessment scores (MMSE, MoCA, CDR). Update renewal processes to require repeat cognitive testing every 3 months. Claims will be denied without proper prior authorization.