MedicaidPrior AuthMedium impact
MAB2020111205
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Multiple Sclerosis agents, including new guidelines for specific drugs like Zeposia requiring varicella zoster virus documentation and revised criteria for non-preferred agents with dosing intervals exceeding 90 days.
Action Required
By January 5, 2021: Billing team must update prior authorization workflows for Multiple Sclerosis agents to include new requirements for varicella zoster virus documentation for Zeposia (ozanimod), revised criteria for non-preferred agents with dosing intervals exceeding 90 days, and new renewal assessment guidelines. Update pharmacy prior authorization forms and provider documentation requirements. Failure to meet new criteria will result in prior authorization denials.