MedicaidPrior AuthMedium impact
MAB2022110907
Pennsylvania Medicaid (DHS)·PA · Rheumatology, Dermatology, Gastroenterology +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization guidelines for Cytokine and CAM Antagonists (biologics used for autoimmune conditions) effective January 9, 2023. Key changes include new coverage for alopecia areata treatment, revised psoriasis and psoriatic arthritis criteria, removal of some hidradenitis suppurativa requirements, and addition of safety screening requirements for JAK inhibitors.
Action Required
Before January 9, 2023: Billing team must update prior authorization processes for all Cytokine and CAM Antagonist prescriptions for Pennsylvania Medicaid patients. Providers must ensure specialist consultation documentation, appropriate safety screening results (TB and Hepatitis B testing), and compliance with new condition-specific guidelines. Update EMR templates to include required documentation elements. Claims will be denied without proper prior authorization.