MedicaidPrior AuthMedium impact
MAB2026033001
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Mar 30, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Sickle Cell Anemia Agents, making Siklos (hydroxyurea) tablet preferred but requiring prior auth for patients 18+ years old. New guidelines added for non-preferred hydroxyurea formulations with specific medical necessity criteria.
Action Required
Immediately: Update prior authorization processes for Sickle Cell Anemia Agents for Pennsylvania Medicaid patients. Ensure prescriptions for Siklos (hydroxyurea) tablets require prior auth for patients 18+ years old. Verify all requests include prescriber consultation with hematologist/oncologist or sickle cell specialist. For non-preferred agents, document therapeutic failure, contraindications, or dosing requirements with preferred options. Reference updated handbook pages at https://www.pa.gov/agencies/dhs/resources/pharmacy-services/clinical-guidelines.