MedicaidPrior AuthMedium impact
MAB2022110902
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for non-preferred oral glucocorticoids (steroids), requiring FDA-approved indications, appropriate dosing, and documentation of failure/contraindication to preferred alternatives. The policy also updates quantity limit requirements for all oral glucocorticoids.
Action Required
Before January 9, 2023: Billing team and providers must implement prior authorization procedures for non-preferred oral glucocorticoids for Pennsylvania Medicaid patients. Update workflows to ensure documentation includes: FDA-approved indication or medically accepted use, appropriate dosing consistent with labeling/literature, and history of therapeutic failure or contraindication to preferred alternatives. Review Pennsylvania PDL to identify preferred vs non-preferred oral glucocorticoids. Claims for non-preferred glucocorticoids without prior authorization will be denied.