MedicaidPrior AuthMedium impact
MAB2020111202
Pennsylvania Medicaid (DHS)·PA · Cardiology, Endocrinology, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for ACL inhibitor drugs (including bempedoic acid) in the Lipotropics category, effective January 5, 2021. This adds to existing prior authorization requirements for non-preferred lipotropics and PCSK9 inhibitors.
Action Required
By January 5, 2021: Billing team must update prior authorization tracking for Pennsylvania Medicaid patients prescribed ACL inhibitor drugs (bempedoic acid). Ensure providers obtain prior authorization before prescribing any non-preferred lipotropics, PCSK9 inhibitors, or ACL inhibitors. Update pharmacy billing systems to flag these medications for PA requirements. Claims will be denied without proper prior authorization.