MedicaidPrior AuthMedium impact
MAB2020110604
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Rheumatology, Family 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 bone density regulator medications (osteoporosis drugs), including new criteria for anabolic agents like Evenity (romosozumab). The changes include stricter requirements for T-scores, therapeutic failure documentation, and contraindication screening for various bone density medications.
Action Required
By January 5, 2021: Providers prescribing bone density regulators for Pennsylvania Medicaid patients must update prior authorization documentation to include new requirements: complete secondary osteoporosis workup (CBC, vitamin D, calcium, phosphorus, albumin, protein, creatinine, liver enzymes, PTH, TSH, urinary calcium, testosterone for males), stricter T-score criteria for anabolic agents (-3.5 or -2.5 with fracture history), and cardiovascular contraindication screening for Evenity. Update EMR templates to capture required elements or prior authorizations will be denied.