MedicaidPrior AuthMedium impact
Prior Authorization of Oncology Agents, Breast Cancer – Pharmacy Services MAB 01-17-26
Pennsylvania Medicaid (DHS)·PA · Oncology, Hematology, Endocrinology·Prior Authorization
Effective date
Jun 6, 2017
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all letrozole prescriptions regardless of quantity, specifically excluding fertility treatment uses. This affects oncology and breast cancer treatment prescriptions effective June 6, 2017.
Action Required
Immediately: Billing team must update prior authorization protocols for all letrozole prescriptions for Pennsylvania Medicaid patients. Providers must document FDA-approved indications or medically accepted uses excluding fertility treatment. Add letrozole to prior auth requirement lists and update encounter forms to prompt documentation of diagnosis and medical necessity. Claims without prior authorization will be denied.