MedicaidPrior AuthMedium impact
MAB2022110802
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Rheumatology, Pharmacy·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania's Medical Assistance program is updating prior authorization requirements for Antifibrotic Respiratory Agents (formerly called IPF Agents), removing drug interaction guidelines and renaming the therapeutic class. All prescriptions for these medications still require prior authorization with specific medical necessity criteria.
Action Required
By January 9, 2023: Billing team should update any internal references from 'Idiopathic Pulmonary Fibrosis (IPF) Agents' to 'Antifibrotic Respiratory Agents' in billing systems and prior authorization workflows. Review updated medical necessity guidelines to ensure proper documentation is obtained from pulmonologists or rheumatologists before submitting prior authorization requests for Pennsylvania Medical Assistance patients.