MedicaidPrior AuthMedium impact
MAB2020111001
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Internal Medicine, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for HIV/AIDS antiretroviral medications, adding new therapeutic duplication guidelines for integrase strand transfer inhibitors and single-tablet regimens. This affects pharmacies and prescribers in Pennsylvania's Medical Assistance program including managed care organizations.
Action Required
By January 5, 2021: Pennsylvania providers prescribing HIV/AIDS antiretrovirals must obtain prior authorization for integrase strand transfer inhibitors and single-tablet regimens when there is therapeutic duplication. Update prescribing protocols to check for existing medications and document medical necessity or transition plans. Pharmacies must verify prior authorization before dispensing these combinations.