MedicaidPrior AuthMedium impact
MAB2019120504
Pennsylvania Medicaid (DHS)·PA · Cardiology, Endocrinology, Family Medicine +2 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Lipotropics (cholesterol medications) effective January 1, 2020. Key changes include removal of discontinued Kynamro, revised guidelines for PCSK9 inhibitors based on new consensus treatment guidelines, and updated renewal requirements for all agents in this class.
Action Required
By January 1, 2020: Pennsylvania providers must update prior authorization procedures for Lipotropic medications. Review updated Medical Assistance handbook for new PCSK9 inhibitor requirements including specialist consultation documentation, lipid profile results within 3 months, and specific LDL-C goals. Update billing workflows to ensure proper documentation of therapeutic failures and contraindications before prescribing non-preferred agents. Verify revalidation dates in PROMISe system and submit applications 60 days prior to expiration.