MedicaidPrior AuthMedium impact
MAB2022120901
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Pulmonology, Dermatology +3 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for monoclonal antibody medications (Anti-IL, Anti-IgE, Anti-TSLP) including revised guidelines for chronic idiopathic urticaria, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic syndrome. The class name has been expanded to include Anti-TSLP medications and new therapeutic failure requirements have been added.
Action Required
Before January 9, 2023: Billing and clinical teams must update prior authorization procedures for monoclonal antibody medications in Pennsylvania Medicaid patients. Ensure appropriate specialist consultation is documented (pulmonologist, allergist, immunologist, dermatologist, hematologist/oncologist, rheumatologist). Update documentation requirements for chronic idiopathic urticaria (6+ weeks duration, steroid requirement or H1 antihistamine failure), EGPA (asthma history, eosinophil counts, rituximab/cyclophosphamide trial history), and hypereosinophilic syndrome cases. Verify preferred drug list compliance before prescribing non-preferred agents.