MedicaidPrior AuthMedium impact
MAB2022111004
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for diabetes medications (hypoglycemics, insulin, and GLP-1 receptor agonists) effective January 9, 2023. Key changes include removing prior auth requirements for preferred GLP-1 combination agents within quantity limits, adding prior auth for therapeutic duplications of GLP-1 drugs, and revising guidelines for non-preferred medications and Afrezza insulin.
Action Required
Before January 9, 2023: Billing and pharmacy teams must update prior authorization protocols for Pennsylvania Medicaid patients receiving diabetes medications. Remove prior auth requirements for preferred GLP-1 combination agents within quantity limits. Add prior auth screening for therapeutic duplications of GLP-1 receptor agonists and DPP-4 inhibitors. Update Afrezza insulin authorization requirements to include endocrinologist prescription requirement. Train staff on revised medical necessity guidelines for non-preferred hypoglycemic agents.