MedicaidPrior AuthMedium impact
Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled – Pharmacy Services MAB 01-19-07
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Cardiology, Pediatrics +1 more·Prior Authorization
Effective date
Jan 28, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated prior authorization guidelines for pulmonary arterial hypertension (PAH) medications, adding a 90-day grandfather provision that automatically approves non-preferred PAH drugs if the patient had a paid claim for the same medication within the past 90 days. The policy also establishes specific criteria for PDE5 inhibitors and includes automated prior authorization for certain medications.
Action Required
Pharmacy staff must verify the 90-day grandfather provision is configured in the Point-Of-Sale system to automatically approve non-preferred PAH medications if patients have prior paid claims within 90 days. Update prior authorization request procedures to include new medical necessity criteria for PDE5 inhibitors and pediatric dosing limits for Revatio. Ensure automated prior authorization is enabled for Adcirca and Revatio at or below quantity limits when clinical guidelines are met.