MedicaidPrior AuthMedium impact
MAB2021110201
Pennsylvania Medicaid (DHS)·PA · Hematology, Pharmacy·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for antihemophilia agents (blood clotting medications for hemophilia), effective January 3, 2022. All prescriptions for these medications now require prior authorization, with specific guidelines for preferred vs non-preferred agents and requirements for prescriber qualifications.
Action Required
By January 3, 2022: Billing team must ensure all antihemophilia agent prescriptions for Pennsylvania Medicaid patients have prior authorization before dispensing. Verify prescriptions are from hematologists or hemophilia treatment center practitioners. For non-preferred agents, confirm documentation of failure with preferred agents or contraindications is included with prior auth requests. Claims without proper prior authorization will be denied.