MedicaidPrior AuthMedium impact
MAB2022110806
Pennsylvania Medicaid (DHS)·PA · Dermatology, Allergy & Immunology, Pulmonology·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for Dupixent (dupilumab), adding new specialist prescription requirements, age-appropriateness criteria, and specific treatment failure guidelines for atopic dermatitis and eosinophilic esophagitis. All Dupixent prescriptions require prior authorization with enhanced documentation starting January 9, 2023.
Action Required
Before January 9, 2023: Billing and clinical teams must update prior authorization workflows for all Dupixent prescriptions to ensure specialist involvement (pulmonologist, allergist, immunologist, dermatologist, etc.) and document treatment failure history. Update EMR templates to capture required trial periods: 4-week topical corticosteroid trials and 8-week topical calcineurin inhibitor trials for atopic dermatitis patients. Verify patient age-appropriateness per FDA labeling before prescribing. Claims without proper prior authorization will be denied.