MedicaidPrior AuthMedium impact
ForwardHealth Update 2025-27: Prior Authorization Changes for Certain Preferred Drug List Classes, Anti-Obesity Drugs, and Other Pharmacy Policy Effective November 1, 2025
Wisconsin ForwardHealth·WI · Neurology, Endocrinology, Rheumatology +2 more·Prior Authorization
Effective date
Nov 1, 2025
We identified it
Jun 18, 2026
Summary
ForwardHealth (Wisconsin Medicaid) is implementing new prior authorization requirements for several drug classes effective November 1, 2025, including Alzheimer's agents (Leqembi IQLIK), bone resorption drugs (Bonsity and teriparatide), oral glucocorticoids (Jaythari and Pyquvi), and anti-obesity medications. These changes require specific clinical documentation and PA forms to be submitted through pharmacies.
Action Required
By November 1, 2025: Providers must update their prior authorization processes for Wisconsin Medicaid patients requiring Leqembi IQLIK, Bonsity, teriparatide, Jaythari, or Pyquvi. Complete PA/DGA form F-11049 with specific clinical criteria documentation and send to pharmacy (not directly to ForwardHealth). Update EMR templates to include required clinical justifications and ensure medical records document treatment history, baseline assessments, and clinical improvement for renewals.