MedicaidPrior AuthMedium impact
MAB2021111205
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Pediatrics, OB-GYN +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated prior authorization requirements for Pituitary Suppressive Agents (LHRH medications) effective January 3, 2022. New guidelines added for central precocious puberty and revised requirements for Myfembree (relugolix/estradiol/norethindrone acetate) approval.
Action Required
By January 3, 2022: Billing and clinical teams must update prior authorization workflows for all Pituitary Suppressive Agents/LHRH medications in Pennsylvania Medicaid patients. Ensure providers document new requirements for central precocious puberty (age ≤11 for females, ≤12 for males, pediatric endocrinologist consultation) and Myfembree prescriptions. Update prior auth request forms to include required clinical criteria. Claims will be denied without proper prior authorization.