MedicaidPrior AuthMedium impact
MAB2020121503
Pennsylvania Medicaid (DHS)·PA · Cardiology, Pharmacy, Pediatrics·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Corlanor (ivabradine), a heart failure medication. The new guidelines expand coverage to pediatric patients, require consultation with a cardiologist, and add specific criteria for therapeutic failure or contraindication to standard heart failure medications including beta blockers.
Action Required
By January 5, 2021: Billing and clinical teams must update prior authorization procedures for Corlanor (ivabradine) prescriptions for Pennsylvania Medicaid patients. Ensure all requests include documentation of: 1) FDA-approved or medically accepted indication, 2) appropriate dosing per FDA labeling or medical literature, 3) cardiologist consultation, 4) no contraindications, and 5) therapeutic failure/intolerance to ACE inhibitors/ARBs and beta blockers. For renewals, document continued clinical benefit and tolerability. Update EMR templates to capture required documentation elements.