MedicaidPrior AuthLow impact
MAB2022071403
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization guidelines for hypoglycemic and metformin medications, clarifying language for consistency but making no substantive changes to existing medical necessity requirements. The policy affects pharmacies and prescribers in Pennsylvania's Medical Assistance program.
Action Required
By September 1, 2022: Review updated prior authorization guidelines for hypoglycemic and metformin prescriptions in Pennsylvania Medicaid patients. Ensure staff understands that non-preferred drugs and quantities exceeding limits still require prior authorization with documentation of therapeutic failure, contraindication, or intolerance to preferred options.