MedicaidPrior AuthMedium impact
MAB2019120604
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Cardiology, Rheumatology +1 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Starting January 1, 2020, all oral and inhaled pulmonary arterial hypertension (PAH) medications now require prior authorization for Pennsylvania Medical Assistance (Medicaid) patients. The policy removes automatic prior authorization for Adcirca and Revatio and establishes strict clinical criteria including specialist consultation and diagnostic testing requirements.
Action Required
By January 1, 2020: Billing and clinical teams must obtain prior authorization for ALL oral and inhaled PAH medications for PA Medicaid patients before prescribing or dispensing. Update pharmacy systems to flag these medications. Providers must ensure consultation with appropriate specialists (pulmonologist, cardiologist) and obtain required diagnostic documentation including right heart catheterization results. Claims will be denied without proper prior authorization.