MedicaidPrior AuthMedium impact
MAB2021111202
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Allergy & Immunology, Dermatology +3 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Monoclonal Antibodies (MABs) - Anti-IL Anti-IgE drugs, removing several previous requirements including parasitic infection guidelines, immunization requirements, and serum IgE testing for Xolair. New guidelines were added for hypereosinophilic syndrome treatment.
Action Required
By January 3, 2022: Billing team and providers must update prior authorization procedures for Monoclonal Antibodies (MABs) - Anti-IL Anti-IgE drugs including Dupixent, Xolair, and similar medications. Remove documentation requirements for parasitic infections, immunizations, dapsone/sulfasalazine trials for chronic urticaria, and serum IgE levels for asthma patients on Xolair. Add new hypereosinophilic syndrome criteria including FIP1L1-PDGFRA-negative status and blood eosinophil counts ≥1000 cells/microL. Ensure specialist consultation requirements (pulmonologist, allergist, immunologist, dermatologist, etc.) are documented for all requests.