MedicaidPrior AuthLow impact
MAB2022071304
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Infectious Disease, Internal Medicine +2 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania's Medical Assistance program updated prior authorization requirements for Hepatitis B agents, effective September 1, 2022. The policy clarifies that non-preferred Hepatitis B drugs and quantities exceeding limits require prior authorization, with updated medical necessity guidelines for review.
Action Required
By September 1, 2022: Billing and pharmacy teams must ensure prior authorization is obtained for non-preferred Hepatitis B agents and quantities exceeding limits before dispensing. Review the updated Prior Authorization of Pharmaceutical Services Handbook and check the Preferred Drug List at papdl.com for current preferred agents. Claims without proper prior authorization will be denied.