MedicaidPrior AuthLow impact
MAB2020121404
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) will require prior authorization for all Duchenne Muscular Dystrophy antisense oligonucleotide drugs starting January 5, 2021. This includes Exondys 51, Vyondys 53, and Viltepso, with specific requirements for neurologist involvement and corticosteroid concurrent therapy.
Action Required
By January 5, 2021: Pharmacy staff must obtain prior authorization for all DMD antisense oligonucleotide prescriptions (Exondys 51, Vyondys 53, Viltepso) for Pennsylvania Medicaid patients. Ensure prescriptions include neurologist consultation documentation, baseline motor function assessment, and concurrent corticosteroid therapy unless contraindicated. Claims will be denied without proper prior authorization.