MedicaidPrior AuthMedium impact
MAB2021111502
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Internal Medicine, Family Medicine·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization guidelines for ulcerative colitis medications, adding new requirements for Zeposia (ozanimod) and clarifying rules for non-preferred brand/generic drugs. Pharmacies and prescribers must follow new medical necessity criteria when requesting prior authorization for these medications.
Action Required
By January 3, 2022: Providers prescribing ulcerative colitis agents to Pennsylvania Medicaid patients must update prior authorization procedures. For Zeposia (ozanimod), always obtain prior authorization using specific Zeposia guidelines. For non-preferred ulcerative colitis agents, document therapeutic failure, contraindication, or intolerance of preferred agents, or show current 90-day history of same non-preferred medication (excluding brand/generic switches). Update EMR templates to capture required medical necessity documentation. Claims without proper prior authorization will be denied.