MedicaidPrior AuthLow impact
MAB2021110202
Pennsylvania Medicaid (DHS)·PA · Pharmacy, Neurology, Geriatrics +2 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is removing prior authorization requirements for preferred Alzheimer's agents and clarifying when prior auth is needed for therapeutic duplication. Only non-preferred agents, quantity limit overages, and acetylcholinesterase inhibitor duplications will require prior authorization.
Action Required
By January 3, 2022: Pharmacy teams must update prior authorization workflows to stop requiring prior auth for preferred Alzheimer's agents. Review current acetylcholinesterase inhibitor claims for therapeutic duplication requirements. Update pharmacy management systems to reflect new prior auth rules for non-preferred agents only.