MedicaidPrior AuthMedium impact
MAB2020121402
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will require prior authorization for all Palforzia (peanut allergen powder) prescriptions starting January 5, 2021. Prescriptions must meet specific clinical criteria including confirmed peanut allergy testing, prescription by an allergist/immunologist, and concurrent epinephrine prescription.
Action Required
By January 5, 2021: Billing team must update system to flag all Palforzia prescriptions for prior authorization for Pennsylvania Medicaid patients. Providers must obtain prior auth from appropriate specialist (allergist/immunologist) with required documentation including peanut allergy test results, epinephrine prescription, and patient instruction on peanut-avoidant diet. Claims without prior authorization will be denied.