MedicaidPrior AuthMedium impact
Prior Authorization of Pancreatic Enzymes – Pharmacy Services MAB 01-19-69
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Pediatrics, Internal Medicine +2 more·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for non-preferred pancreatic enzymes, allowing patients to continue receiving the same non-preferred enzyme if prescribed within the past 90 days. This creates a new pathway for prior authorization approval based on recent prescription history.
Action Required
By January 1, 2020: Billing team must update prior authorization workflows for pancreatic enzyme prescriptions in Pennsylvania Medicaid cases. When submitting prior auth requests for non-preferred pancreatic enzymes, include documentation of prescription history within past 90 days as an alternative to therapeutic failure documentation. Update staff training to inform prescribers of this new approval pathway.