MedicaidPrior AuthMedium impact
Microsoft Word - Phase2MAB.doc
Pennsylvania Medicaid (DHS)·PA · Pharmacy·Provider Bulletin
Effective date
Nov 1, 2005
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing Phase 2 of their Preferred Drug List (PDL), requiring prior authorization for non-preferred drugs and some preferred drugs starting December 1, 2005. There is a transition period in November where claims won't be denied for non-preferred drugs to allow providers time to adjust.
Action Required
Before December 1, 2005: Billing team and providers must review the updated Preferred Drug List Attachment 1 to identify which drugs now require prior authorization. Update pharmacy billing systems to flag non-preferred drugs for prior auth requirements. Follow handbook procedures in 55 Pa. Code § 1101.67(a) for prior authorization requests. Providers should transition patients to preferred drugs or obtain prior authorization for non-preferred drugs during November transition period to avoid claim denials starting December 1st.