MedicaidPrior AuthMedium impact
MAB2020121501
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Genetics, Nephrology +3 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for all Crysvita (burosumab) prescriptions effective January 5, 2021. This specialty medication treats X-linked hypophosphatemia and tumor-induced osteomalacia and requires extensive clinical documentation including genetic testing, lab values, and specialist consultation.
Action Required
By January 5, 2021: Billing team must ensure all Crysvita (burosumab) prescriptions for Pennsylvania Medicaid patients have prior authorization before dispensing. Providers must collect required documentation including PHEX gene mutation results, baseline phosphate levels, FGF23 levels, and specialist consultation notes. Update billing system to flag this medication for PA requirements. Claims will be denied without proper prior authorization.