MedicaidPrior AuthLow impact
MAB2021110801
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Internal Medicine, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for HIV/AIDS antiretroviral medications, including new guidelines for Cabenuva and clarifications for therapeutic duplication scenarios. This affects pharmacies and prescribers serving Medicaid patients requiring these medications.
Action Required
By January 3, 2022: Providers prescribing HIV/AIDS antiretrovirals to Pennsylvania Medicaid patients must review updated prior authorization requirements. Update workflows to ensure prior auth requests for non-preferred drugs, Cabenuva, quantity limit overrides, and therapeutic duplications include proper medical necessity documentation. Pharmacies must verify prior authorization status before dispensing covered medications.