MedicaidPrior AuthMedium impact
MAB2022110805
Pennsylvania Medicaid (DHS)·PA · Neurology, Pediatrics, Endocrinology +1 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Corticotropin prescriptions (formerly H.P. Acthar Gel). All prescriptions must receive prior authorization approval, with specific medical necessity criteria including documented failure of IV methylprednisolone and oral corticosteroids for conditions other than infantile spasms.
Action Required
By January 9, 2023: Billing team and providers must ensure all Corticotropin prescriptions receive prior authorization before dispensing for Pennsylvania Medicaid patients. Update pharmacy workflows to flag these prescriptions. Document therapeutic failure or contraindications to IV methylprednisolone and oral corticosteroids for all conditions except infantile spasms. Claims will be denied without proper prior authorization.