MedicaidPrior AuthHigh impact
MAB2025122201
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +4 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is revising prior authorization requirements for GLP-1 Receptor Agonists (diabetes medications like Ozempic, Mounjaro) effective January 1, 2026. The changes clarify renewal guidelines for diabetes treatment and confirm these medications are NOT covered for weight loss or obesity treatment.
Action Required
By January 1, 2026: Update prior authorization procedures for all GLP-1 Receptor Agonist prescriptions for Pennsylvania Medicaid patients. Ensure staff understand these medications require prior auth for diabetes, cardiovascular risk reduction, sleep apnea, and liver disease but are NOT covered for weight loss/obesity. Saxenda (liraglutide) will no longer be covered for any indication. Review current patients on these medications to ensure proper documentation and reauthorization as needed.