MedicaidPrior AuthMedium impact
MAB2019120503
Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Pulmonology, Dermatology +1 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for monoclonal antibodies (Anti-IL, Anti-IgE drugs like Dupixent, Xolair, Nucala, etc.) to add a new restriction prohibiting combination use of multiple MAB drugs. All other existing prior auth criteria remain unchanged.
Action Required
By January 1, 2020: Billing team must ensure prior authorization requests for monoclonal antibodies (Anti-IL, Anti-IgE) include documentation that the requested drug will NOT be used in combination with another MAB drug. Update prior auth checklists and notify providers prescribing Dupixent, Xolair, Nucala, Cinqair, or Fasenra to document no concurrent MAB use. Claims may be denied without proper documentation.