MedicaidPrior AuthMedium impact
MAB2021110203
Pennsylvania Medicaid (DHS)·PA · Rheumatology, Endocrinology, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for antihyperuricemic medications (gout treatments), removing prior auth requirements for single-ingredient colchicine agents and revising guidelines for non-preferred medications and Krystexxa (pegloticase) to align with American College of Rheumatology recommendations.
Action Required
By January 3, 2022: Billing team must update prior authorization protocols for Pennsylvania Medicaid patients receiving antihyperuricemic medications. Remove prior auth requirements for single-ingredient colchicine agents. Update documentation requirements for non-preferred antihyperuricemics and Krystexxa to align with new American College of Rheumatology guidelines. Review current PA Medicaid patients on these medications to ensure compliance with updated criteria.