MedicaidPrior AuthMedium impact
MAB2020110906
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Infectious Disease, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Hepatitis C medications, effective January 5, 2021. The changes include revised clinical guidelines for determining medical necessity, requiring additional testing documentation including HCV RNA, genotyping when recommended by AASLD, and hepatitis B/HIV screening results.
Action Required
By January 5, 2021: Billing team and providers must ensure all Hepatitis C medication prior authorization requests include complete documentation per updated guidelines: detectable HCV RNA results, genotype testing when AASLD-recommended, hepatitis B immunization status or screening results, HIV screening results, RAS testing if recommended, and Metavir fibrosis score. Update prior authorization request templates to include all required elements. Incomplete requests will be denied.