MedicaidPrior AuthMedium impact
Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services MAB 01-19-10
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Prior Authorization
Effective date
Jan 28, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Multiple Sclerosis medications, changing Aubagio from non-preferred to preferred status and removing Zinbryta from prior auth guidelines due to manufacturer discontinuation. Specific medications including Aubagio, Ampyra, Gilenya, Tysabri, and Tecfidera now require prior authorization regardless of quantity prescribed.
Action Required
By January 28, 2019: Pharmacy and prescriber staff must update prior authorization processes for Multiple Sclerosis agents including Aubagio (now preferred but still requires prior auth), Ampyra, Gilenya, Tysabri, and Tecfidera. Remove Zinbryta from prior authorization workflows as it has been discontinued. Update billing systems to reflect new preferred drug list status and ensure proper documentation for medical necessity reviews is collected before prescribing.