MedicaidPrior AuthMedium impact
MAB2021110502
Pennsylvania Medicaid (DHS)·PA · Dermatology, Allergy & Immunology, Pulmonology·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Dupixent (dupilumab) effective January 3, 2022, removing some restrictions like specialist consultation requirements for all diagnoses and parasitic infection guidelines, while revising criteria for atopic dermatitis and asthma treatment. All Dupixent prescriptions still require prior authorization with specific medical necessity criteria.
Action Required
By January 3, 2022: Billing team must update prior authorization procedures for Dupixent prescriptions for Pennsylvania Medicaid patients. Review updated medical necessity criteria for atopic dermatitis and asthma indications. Ensure pharmacy staff are aware that specialist consultation is no longer required for all diagnoses but is still required for asthma cases. Update internal prior authorization checklists to reflect revised guidelines.