MedicaidPrior AuthMedium impact
MAB2021111203
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization guidelines for Multiple Sclerosis medications, removing several requirements including drug interaction assessments, infection testing, and vaccination requirements while adding new guidelines for Zeposia. The changes streamline the approval process by eliminating redundant safety checks.
Action Required
By January 3, 2022: Review current Multiple Sclerosis medication prior authorization workflows for Pennsylvania Medicaid patients. Update prior authorization request procedures to align with new simplified guidelines - no longer need to document varicella zoster testing, tuberculosis testing, or drug interaction assessments. Ensure neurologists are aware that some previously required safety documentation is no longer needed for PA requests.