MedicaidPrior AuthMedium impact
MAB2021111501
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Tysabri (natalizumab) prescriptions with new medical necessity guidelines. This drug treats multiple sclerosis and Crohn's disease, requiring specialist prescriptions and specific failure criteria for other treatments.
Action Required
By January 3, 2022: Billing team must ensure all Tysabri (natalizumab) prescriptions for Pennsylvania Medicaid patients have prior authorization before dispensing. Pharmacies and prescribers must follow new medical necessity guidelines including specialist consultation requirements (neurologist for MS, gastroenterologist for Crohn's). Update billing system to flag Tysabri prescriptions for PA verification. Claims without prior auth will be denied.