MedicaidPrior AuthMedium impact
MAB2022110901
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Allergy & Immunology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is implementing new prior authorization requirements for inhaled glucocorticoids (inhaled steroids) used to treat asthma and COPD. The policy requires prior auth for non-preferred drugs, quantities exceeding limits, and therapeutic duplications, with specific allowances for SMART therapy protocols.
Action Required
Before January 9, 2023: Billing team must update prior authorization workflows for inhaled glucocorticoid prescriptions in Pennsylvania Medicaid patients. Train staff to identify when prior auth is required for non-preferred inhaled steroids, quantity limit overrides, and therapeutic duplications. Update pharmacy billing systems to flag these scenarios. Providers must document therapeutic failures, contraindications, or medical necessity for SMART therapy protocols when requesting prior authorization.