MedicaidPrior AuthMedium impact
MAB2022120804
Pennsylvania Medicaid (DHS)·PA · Ophthalmology, Family Medicine, General Practice·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization guidelines for ophthalmic anti-inflammatory medications, removing automated approval processes but keeping the same medical necessity requirements. The change primarily affects format and removes automated approvals - no new clinical criteria were added.
Action Required
By January 9, 2023: Pharmacy and prescribing staff must follow updated prior authorization procedures for non-preferred ophthalmic anti-inflammatory medications and those exceeding quantity limits. Review the updated handbook pages and ensure all PA requests include documentation of therapeutic failure, contraindications, or intolerance to preferred drugs. Note that automated approvals are no longer available - all requests will require manual review.