MedicaidPrior AuthMedium impact
MAB2020121403
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Evrysdi (risdiplam) prescriptions used to treat spinal muscular atrophy. Prescriptions must be written by or in consultation with an experienced SMA neurologist and meet specific clinical criteria including genetic testing confirmation and standardized motor function assessments.
Action Required
Before January 5, 2021: Update billing system to flag all Evrysdi (risdiplam) prescriptions for Pennsylvania Medicaid patients as requiring prior authorization. Ensure prescribing providers are aware they must obtain prior auth and provide documentation of SMA diagnosis with SMN gene mutation, baseline motor function assessment by SMA neurologist, and confirmation patient is not concurrently using Spinraza. Claims will be denied without proper prior authorization.