MedicaidPrior AuthMedium impact
Prior Authorization of Antihyperuricemics – Pharmacy Services MAB 01-19-05
Pennsylvania Medicaid (DHS)·PA · Rheumatology, Family Medicine, Internal Medicine·Prior Authorization
Effective date
Jan 28, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all single-ingredient oral colchicine agents (gout medications) and has updated medical necessity criteria for lesinurad-containing drugs. Previously, only non-preferred antihyperuricemic drugs required prior auth.
Action Required
By January 28, 2019: Billing team and providers must obtain prior authorization for ALL single-ingredient oral colchicine prescriptions for Pennsylvania Medicaid patients, regardless of preferred status. Update billing system to flag colchicine prescriptions for prior auth. Providers must document therapeutic failure or contraindication to NSAIDs/corticosteroids for acute gout treatment, or provide recent uric acid levels and treatment history for chronic gout. Claims will be denied without proper prior authorization.