MedicaidPrior AuthMedium impact
MAB2021111201
Pennsylvania Medicaid (DHS)·PA · Cardiology, Endocrinology, Family Medicine +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 lipotropic medications, including new drug Evkeeza and revised guidelines for PCSK9 inhibitors, ACL inhibitors, and other cholesterol medications. The policy removes some previous requirements like specialist consultation for PCSK9 inhibitors but adds stricter renewal criteria.
Action Required
By January 3, 2022: Billing team must update prior authorization procedures for lipotropic medications in Pennsylvania Medicaid patients. Verify all non-preferred lipotropics, PCSK9 inhibitors (Praluent, Repatha), ACL inhibitors (Nexletol, Nexlizet), MTP inhibitors (Juxtapid), and new ANGPTL3 inhibitor (Evkeeza) have prior authorization before prescribing. Update provider workflow to ensure lipid profile documentation within 3 months and therapeutic failure documentation for specialty lipotropics. Claims without proper prior authorization will be denied.