MedicaidPrior AuthMedium impact
ForwardHealth Update 2026-04: March 2026 Changes for Certain Preferred Drug List Classes and Other Pharmacy Policy
Wisconsin ForwardHealth·WI · Infectious Disease, Endocrinology, Neurology·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 18, 2026
Summary
ForwardHealth (Wisconsin Medicaid) is implementing new prior authorization requirements and clinical criteria for antibiotics (Blujepa/Orlynvah) and lipotropics (Redemplo/Tryngolza), plus policy changes for spinal muscular atrophy drugs. New forms and stricter documentation requirements take effect March 1, 2026.
Action Required
By March 1, 2026: Update prior authorization workflows for Blujepa, Orlynvah, Redemplo, and Tryngolza prescriptions. Pharmacy staff must use revised PA/PDL form F-03412 (03/2026) for Blujepa/Orlynvah requests and PA/DGA form F-11049 (01/2024) Section VI for Redemplo/Tryngolza. Ensure prescribers complete genetic testing documentation for lipotropics and that lipid management specialists write prescriptions. Update system to prevent concurrent SMA drug approvals with required 90-day waiting periods for transitions.