MedicaidPrior AuthHigh impact
MAB2019120602
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Pediatrics, Pharmacy·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for ALL growth hormone prescriptions effective January 1, 2020, with updated medical necessity guidelines including specific requirements for pediatric, adult, and condition-specific treatments.
Action Required
By January 1, 2020: Billing team and providers must obtain prior authorization for ALL growth hormone prescriptions for Pennsylvania Medicaid patients before dispensing. Update billing system to flag all growth hormone prescriptions for PA requirement. Providers must ensure documentation meets new medical necessity criteria including appropriate specialist prescribing, FDA-approved indications, age-appropriate dosing, and condition-specific requirements. Claims will be denied without proper prior authorization.