MedicaidPrior AuthLow impact
MAB2020121504
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for Spinraza (nusinersen), a spinal muscular atrophy treatment. Key changes include removing specific SMA type restrictions, adding dose verification requirements, and prohibiting concurrent use with Evrysdi (risdiplam).
Action Required
By January 5, 2021: Billing team should update prior authorization procedures for Spinraza (nusinersen) prescriptions to include new requirements: verify FDA-approved dosing, confirm no concurrent Evrysdi use, and ensure neurologist involvement. Update PA request forms and checklists accordingly. Note this only affects Pennsylvania Medicaid fee-for-service patients.