MedicaidPrior AuthMedium impact
MAB2022110804
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Hematology, Oncology +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for CMV antiviral medications, including updated guidelines for letermovir and new requirements for maribavir. All non-preferred CMV antivirals will now require prior authorization with specific medical necessity criteria.
Action Required
By January 9, 2023: Billing and clinical teams must update workflows to obtain prior authorization for all non-preferred CMV antivirals, letermovir, and any CMV antiviral exceeding quantity limits for Pennsylvania Medicaid patients. Providers must document specialist consultation, treatment history, and specific clinical criteria per the updated guidelines. Claims will be denied without proper prior authorization.