MedicaidAdministrativeLow impact
MAB2022111003
Pennsylvania Medicaid (DHS)·PA · Ophthalmology·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is changing the name of the 'Ophthalmics, Immunomodulators' therapeutic class to 'Dry Eye Treatments' but keeping all prior authorization requirements the same. Non-preferred dry eye medications and quantities exceeding limits still require prior authorization.
Action Required
By January 9, 2023: Billing team should update any internal documentation or billing system references from 'Ophthalmics, Immunomodulators' to 'Dry Eye Treatments' for Pennsylvania Medicaid prior authorization requests. No changes to actual prior authorization procedures or requirements are needed.