MAB2026070102

By July 6, 2026: Billing and clinical staff must implement updated prior authorization procedures for all intra-articular hyaluronate prescriptions submitted to Pennsylvania MA (Medicaid). Specific actions: (1) Update prior authorization submission templates to clearly document improvement in pain or joint function following the MOST RECENT treatment (not initial treatment) for renewal requests; (2) Ensure all initial prior authorization requests include documented failure/contraindication/intolerance to non-pharmacologic treatments, acetaminophen or NSAIDs, and intra-articular glucocorticoid injection; (3) Verify prescriptions use preferred agents from the PA Preferred Drug List (https://papdl.com/preferred-drug-list) or document therapeutic failure of preferred agents; (4) Configure billing system to flag all intra-articular hyaluronate prescriptions for prior authorization review before submission; (5) Train providers and clinical staff on new renewal documentation requirements emphasizing 'most recent treatment' language. Consequences: Claims lacking proper prior authorization or missing required clinical documentation will be denied. This applies to fee-for-service MA only; managed care organizations have separate requirements.