MedicaidPrior AuthMedium impact
MAB2021110504
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Rheumatology, Orthopedics +3 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 bone density regulator medications effective January 3, 2022. The changes include revised guidelines for Evenity, Tymlos, and Forteo that reflect cost-effectiveness considerations for teriparatide, requiring additional documentation of contraindications or intolerances between similar medications.
Action Required
By January 3, 2022: Providers prescribing bone density regulators for Pennsylvania Medicaid patients must update prior authorization processes to include new clinical guidelines. Pharmacy staff must verify additional contraindication and intolerance documentation requirements for Evenity, Tymlos, and Forteo. Review updated handbook pages at the provided DHS links and ensure all bone density regulator prescriptions meet the revised medical necessity criteria to avoid claim denials.