MedicaidPrior AuthMedium impact
MAB2021111602
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 prescriptions of Zeposia (ozanimod), a medication for multiple sclerosis and ulcerative colitis. The drug must be prescribed by appropriate specialists and meet specific medical necessity criteria including failure of preferred alternatives.
Action Required
By January 3, 2022: Billing and clinical teams must ensure prior authorization is obtained for all Zeposia (ozanimod) prescriptions for Pennsylvania Medicaid patients. Neurologists prescribing for multiple sclerosis and gastroenterologists prescribing for ulcerative colitis must document failure of preferred alternatives and follow medical necessity guidelines. Update pharmacy systems to flag this medication for prior auth requirements. Claims will be denied without proper prior authorization.