MedicaidPrior AuthMedium impact
MAB2022121301
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is removing prior authorization requirements for preferred diabetes medications (hypoglycemics and incretin mimetics/enhancers) when prescribed within quantity limits and without therapeutic duplication. Non-preferred medications and therapeutic duplications will still require prior authorization with updated medical necessity guidelines.
Action Required
By January 9, 2023: Update prior authorization workflows for Pennsylvania Medicaid patients with diabetes medications. Remove prior auth requirements for preferred hypoglycemics and incretin mimetics/enhancers (GLP-1 agonists, DPP-4 inhibitors) when within quantity limits. Continue requiring prior auth for non-preferred drugs and therapeutic duplications. Update billing system rules and train staff on new guidelines to avoid unnecessary prior auth delays.