MedicaidPrior AuthMedium impact
MAB2022110906
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all cholic acid and obeticholic acid prescriptions, plus additional requirements for non-preferred bile salts. New guidelines specify prescriber qualifications, dosing criteria, and documentation requirements for medical necessity determinations.
Action Required
By January 9, 2023: Billing team must update prior authorization protocols for bile salt prescriptions in Pennsylvania Medicaid. Ensure all cholic acid and obeticholic acid prescriptions obtain prior auth before dispensing. Verify prescribers are hepatologists/gastroenterologists for these medications and document therapeutic failure of UDCA for obeticholic acid. Update pharmacy systems to flag these medications for PA requirements.