MedicaidPrior AuthMedium impact
Provider Letter 2026-05: RE: Product-Based Prior Authorization for Hereditary Angioedema Medications Effective May 1, 2026
Oklahoma SoonerCare·OK · Allergy & Immunology, Emergency Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) is implementing new prior authorization requirements for all Hereditary Angioedema (HAE) medications effective May 1, 2026. All HAE prophylaxis and treatment medications will require prior authorization using Form PHARM-321, with tiered approval criteria requiring step therapy through lower-tier options first.
Action Required
By May 1, 2026: Update billing system to flag all HAE medication prescriptions for prior authorization requirement. Train staff to use Form PHARM-321 for HAE medication PA requests and submit to Pharmacy Prior Authorization Unit (not Medical Authorization Unit). Verify patient diagnosis codes, recent weights for weight-based dosing, training documentation, and step therapy justification before submitting requests. Contact SoonerCare Pharmacy PA Unit at 800-522-0114 option 4 for traditional SoonerCare members.