MedicaidPrior AuthMedium impact
MAB2020111002
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding hypoglycemia treatments to their Preferred Drug List requiring prior authorization for non-preferred drugs and quantities exceeding limits. This affects pharmacy billing and prescriber workflows for diabetic patients needing emergency hypoglycemia medications.
Action Required
By January 5, 2021: Pharmacy staff and prescribers must obtain prior authorization for non-preferred hypoglycemia treatments and quantities exceeding limits for Pennsylvania Medicaid patients. Update pharmacy systems to flag these medications for prior auth requirements. Document clinical reasons why preferred treatments cannot be used when requesting authorization for non-preferred options.