MedicaidPrior AuthMedium impact
MAB2021110803
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for COPD medications, adding new therapeutic duplication rules and revising criteria for Daliresp (roflumilast). The changes clarify when prior auth is needed for inhaled COPD agents and remove certain clinical requirements for renewals.
Action Required
By January 3, 2022: Billing and clinical teams must update prior authorization procedures for COPD medications for Pennsylvania Medicaid patients. Review updated guidelines for Daliresp (roflumilast) prescriptions requiring psychiatric evaluation documentation. Ensure prior auth requests for therapeutic duplications of inhaled glucocorticoids, long-acting anticholinergics, and long-acting beta agonists include proper justification. Update clinical documentation templates to capture required elements for medical necessity determinations.