MedicaidPrior AuthMedium impact
MAB2020111601
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding sickle cell agents to their preferred drug list requiring prior authorization for non-preferred drugs, quantities exceeding limits, or when prescribed without meeting specific clinical criteria including 6-month hydroxyurea failure and specialist consultation.
Action Required
By January 5, 2021: Billing and pharmacy teams must update prior authorization procedures for sickle cell agents prescribed to Pennsylvania Medicaid patients. Ensure prescribers document 6-month hydroxyurea therapeutic failure, obtain hematologist/oncologist consultation, verify age-appropriate dosing, and address drug interactions before prescribing. Non-preferred agents or quantities exceeding limits will require prior authorization or claims will be denied.