MedicaidPrior AuthMedium impact
MAB2020110605
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is removing prior authorization requirements for tiotropium when prescribed for asthma diagnosis, while maintaining prior authorization for other COPD agents. The policy includes detailed medical necessity criteria for Daliresp (roflumilast) and other non-preferred COPD medications.
Action Required
By January 5, 2021: Billing and pharmacy teams must update prior authorization workflows to remove tiotropium prior auth requirement for asthma diagnoses in Pennsylvania Medicaid patients. Review and implement updated medical necessity criteria for Daliresp (roflumilast) and other COPD agents. Ensure staff understand the detailed clinical requirements for prior authorization approvals, including severe COPD documentation and therapeutic failure criteria.