MedicaidPrior AuthMedium impact
MAB2022110904
Pennsylvania Medicaid (DHS)·PA · Hematology, Pharmacy·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for antihemophilia agents (blood clotting medications). All antihemophilia agents now require prior authorization with specific medical necessity criteria, including prescriber requirements (must be hematologist or hemophilia treatment center practitioner) and step therapy requirements for non-preferred agents.
Action Required
Before January 9, 2023: Billing team must update prior authorization procedures for all antihemophilia agents for Pennsylvania Medicaid patients. Ensure prescribers understand that all antihemophilia medications require prior auth and must be prescribed by hematologists or hemophilia treatment center practitioners. Update billing system to flag these medications for prior auth verification. Claims will be denied without proper prior authorization.