MedicaidPrior AuthLow impact
MAB2022110905
Pennsylvania Medicaid (DHS)·PA · Cardiology, 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 updating prior authorization requirements for Angiotensin Modulator Combinations (blood pressure medications) to clarify when therapeutic duplication requires prior auth. The medical necessity guidelines remain the same, but the therapeutic duplication criteria have been clarified.
Action Required
By January 9, 2023: Pharmacy and prescribing staff should review updated prior authorization guidelines for Angiotensin Modulator Combinations in Pennsylvania Medicaid patients. Ensure familiarity with therapeutic duplication requirements for ACE inhibitors, ARBs, and calcium channel blockers. Update pharmacy systems to reflect clarified prior authorization triggers for these medication combinations.