MedicaidPrior AuthMedium impact
Prior Authorization of Symdeko (tezacaftor/ivacaftor) – Pharmacy Services MAB 01-19-02
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Pediatrics·Prior Authorization
Effective date
Jan 22, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Symdeko (tezacaftor/ivacaftor) prescriptions effective January 22, 2019. Prescribers must meet specific clinical criteria including cystic fibrosis diagnosis, genetic testing confirmation, and specialist oversight.
Action Required
Immediately: Billing team must notify providers that all Symdeko (tezacaftor/ivacaftor) prescriptions for Pennsylvania Medicaid patients require prior authorization. Update billing system to flag this medication for PA requirements. Ensure prescribers have baseline FEV1, ALT/AST values documented and specialist consultation before prescribing. Claims will be denied without proper prior authorization.