MedicaidPrior AuthMedium impact
MAB - Requirements for Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Jan 20, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for tiotropium when prescribed for asthma diagnosis, effective January 20, 2016. The policy also establishes detailed medical necessity criteria for COPD agents including Daliresp and therapeutic duplication scenarios.
Action Required
By January 20, 2016: Billing team must update prior authorization protocols for Pennsylvania Medicaid patients receiving tiotropium for asthma - verify patient is 12+ years old and on optimally tolerated doses of inhaled glucocorticoids and long-acting beta agonists before prescribing. Pharmacy staff must obtain prior auth for all non-preferred COPD agents, therapeutic duplications, and quantity limit overrides per updated guidelines. Claims will be denied without proper prior authorization.