MedicaidPrior AuthHigh impact
MAB2022120903
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, General Practice +3 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) will begin covering obesity treatment medications effective January 9, 2023, with all prescriptions requiring prior authorization. This represents a significant policy shift as Pennsylvania Medicaid historically did not cover obesity drugs.
Action Required
By January 9, 2023: Billing and clinical teams must implement prior authorization procedures for all obesity treatment medications for Pennsylvania Medicaid patients. Update billing system to flag these prescriptions for prior auth. Providers must document BMI criteria (≥30 kg/m² for adults or ≥95th percentile for children), weight-related comorbidities, lifestyle counseling provided, and PDMP searches for controlled substances. Claims will be denied without proper prior authorization.