MedicaidPrior AuthMedium impact
MAB2020112402
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Tysabri (natalizumab), a medication used to treat multiple sclerosis and Crohn's disease. The changes include new requirements for specialist prescribing, contraindication screening, and revised guidelines for Crohn's disease treatment.
Action Required
By January 5, 2021: Update prior authorization procedures for Tysabri (natalizumab) prescriptions for Pennsylvania Medicaid patients. Ensure neurologists are prescribing for MS patients and gastroenterologists for Crohn's disease patients. Verify contraindication screening is documented before submission. Update PA request forms to include new medical necessity criteria including FDA-approved dosing, age appropriateness, and TNF inhibitor failure history for Crohn's patients.