MedicaidPrior AuthLow impact
MAB2021122801
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Pharmacy, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated HIV/AIDS antiretroviral prior authorization requirements, removing prior auth requirements for Cabenuva and clarifying therapeutic duplication rules. The policy also updated guidelines for non-preferred drug approvals and quantity limit exceptions.
Action Required
By January 3, 2022: Pharmacy and billing staff must update prior authorization protocols for HIV/AIDS antiretrovirals - remove prior auth requirement for Cabenuva (cabotegravir/rilpivirine) and apply new therapeutic duplication rules for NNRTIs, protease inhibitors, integrase inhibitors, and single product regimens. Review updated PA guidelines at provided DHS links before processing HIV medication claims.