MedicaidPrior AuthMedium impact
Prior Authorization of Antibiotics, Inhaled – Pharmacy Services MAB 01-19-15
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Infectious Disease, Internal Medicine +1 more·Prior Authorization
Effective date
Jul 8, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for non-preferred inhaled antibiotics and quantities exceeding limits, with new guidelines for Arikayce (amikacin liposome) and updated medical necessity criteria. This affects prescriptions for inhaled antibiotics in the fee-for-service Medicaid system.
Action Required
By July 8, 2019: Billing team must update prior authorization workflows for Pennsylvania Medicaid patients receiving inhaled antibiotics. Verify preferred drug list status at https://papdl.com/preferred-drug-list before prescribing. Obtain prior authorization for non-preferred inhaled antibiotics or quantities exceeding limits. Ensure documentation includes FDA-approved indication, age-appropriate dosing, therapeutic failure history for non-preferred drugs, and culture/sensitivity results when applicable.