MedicaidPrior AuthMedium impact
MAB2021111702
Pennsylvania Medicaid (DHS)·PA · Nephrology, Rheumatology, Transplant Surgery +2 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for oral immunosuppressive medications, including quantity limit restrictions and specific criteria for the newly approved drug Lupkynis (voclosporin) for lupus nephritis treatment.
Action Required
Before January 3, 2022: Billing and clinical teams must update prior authorization workflows for oral immunosuppressive medications in Pennsylvania Medicaid patients. Ensure prescribers document FDA-approved indications, appropriate dosing, contraindication screening, and for Lupkynis specifically: kidney biopsy confirmation of lupus nephritis, specialist consultation, and combination therapy requirements. Update quantity limit checks in billing system. Claims without proper prior authorization will be denied.