MedicaidPrior AuthMedium impact
MAB2022071401
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Family Medicine, Pediatrics +2 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for non-preferred epinephrine auto-injectors (EpiPens). Only non-preferred brands require prior auth; preferred brands listed on the PDL can be prescribed without authorization. Prior auth will be approved if patient has failed, has contraindication to, or is intolerant of preferred epinephrine products.
Action Required
By September 1, 2022: Billing team must verify which epinephrine auto-injector brands are preferred vs non-preferred on Pennsylvania's PDL at papdl.com. Update prior authorization workflow to only request auth for non-preferred epinephrine products for PA Medicaid patients. Providers must document therapeutic failure, contraindication, or intolerance to preferred products when prescribing non-preferred epinephrine auto-injectors.