MedicaidPrior AuthMedium impact
MAB2020110607
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for all non-preferred H. pylori treatments starting January 5, 2021. Only preferred treatments listed on the Preferred Drug List can be prescribed without prior authorization, and requests must align with American College of Gastroenterology guidelines.
Action Required
By January 5, 2021: Providers treating H. pylori infections must check the Pennsylvania Preferred Drug List before prescribing treatments. For non-preferred H. pylori medications, obtain prior authorization through PROMISe system with documentation showing clinical reasons why preferred treatments cannot be used. Update EMR templates to include ACG guideline compliance documentation. Failure to obtain prior auth will result in claim denials for non-preferred H. pylori treatments.