MedicaidPrior AuthMedium impact
MAB2023062905
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Infectious Disease, Internal Medicine +2 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has removed prior authorization requirements for preferred Hepatitis C medications and streamlined clinical guidelines by eliminating several documentation requirements including baseline HCV RNA testing and HIV screening. Non-preferred Hepatitis C agents still require prior authorization with updated medical necessity criteria.
Action Required
By July 10, 2023: Pharmacy and prescribing staff must update prior authorization workflows to reflect that preferred Hepatitis C agents no longer require prior authorization. Update clinical documentation templates to remove requirements for baseline quantitative HCV RNA and HIV screening documentation. Verify preferred drug list status before prescribing and ensure non-preferred agents still follow prior authorization procedures with updated medical necessity guidelines including FIB-4 calculation for cirrhosis assessment.