MedicaidPrior AuthMedium impact
MAB2026030201
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +3 more·Provider Bulletin
Effective date
Mar 2, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for GLP-1 receptor agonist medications (like Ozempic, Mounjaro, Wegovy), removing the requirement for recent obstructive sleep apnea confirmation within two years and clarifying that Saxenda is no longer covered for any indication. All GLP-1 medications still require prior authorization and are not covered for weight loss/obesity treatment.
Action Required
Immediately: Update prior authorization protocols for GLP-1 receptor agonist prescriptions (Ozempic, Mounjaro, Wegovy, etc.) for Pennsylvania Medicaid patients. Remove Saxenda from formulary as it's no longer covered. Ensure all GLP-1 medications have prior authorization before prescribing, and verify they are not being prescribed for weight loss/obesity. Update provider documentation requirements per the new medical necessity guidelines.