MedicaidPrior AuthMedium impact
MAB2022120801
Pennsylvania Medicaid (DHS)·PA · Cardiology, Internal Medicine, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for platelet aggregation inhibitors effective January 9, 2023. The changes remove Zontivity (vorapaxar) from guidelines and revise criteria for non-preferred medications to consider the beneficiary's specific diagnosis.
Action Required
Before January 9, 2023: Billing and pharmacy staff must update prior authorization procedures for platelet aggregation inhibitors for PA Medicaid patients. Verify preferred drug list status at papdl.com before prescribing non-preferred agents. Ensure documentation includes beneficiary's specific diagnosis, therapeutic failure history, contraindications, or intolerances to preferred medications when requesting prior auth for non-preferred platelet aggregation inhibitors.