MedicaidPrior AuthMedium impact
MAB2022110903
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Hepatitis C medications, effective January 9, 2023. New guidelines require specific documentation including cirrhosis assessment, HIV screening, and resistance testing when recommended by professional guidelines.
Action Required
By January 9, 2023: Providers treating Hepatitis C patients on Pennsylvania Medicaid must ensure all prior authorization requests include: detectable HCV RNA documentation, genotype testing when required, cirrhosis assessment via noninvasive testing, HIV screening results, and RAS testing documentation when recommended by AASLD guidelines. Update prior authorization request workflows to include these required documentation elements. Requests missing required documentation will be denied.