MedicaidPrior AuthMedium impact
MAB2022011201
Pennsylvania Medicaid (DHS)·PA · Neurology, Psychiatry, Geriatrics +1 more·Provider Bulletin
Effective date
Feb 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will require prior authorization for all Aduhelm (aducanumab) prescriptions starting February 1, 2022. The drug must be prescribed by a dementia specialist with specific clinical criteria including PET scan results, cognitive test scores, and MRI findings.
Action Required
By February 1, 2022: Billing team must update prior authorization procedures for Aduhelm (aducanumab) prescriptions for Pennsylvania Medicaid patients. Providers must ensure dementia specialist prescribing, obtain baseline MRI and PET scans, document cognitive assessment scores (MMSE, MoCA, or CDR), and verify no contraindications before submitting prior auth requests. Claims will be denied without proper prior authorization.