MedicaidPrior AuthHigh impact
MAB2025112403
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Pennsylvania Medicaid will no longer cover GLP-1 receptor agonist drugs (like semaglutide, tirzepatide) for weight loss or obesity treatment. These drugs will still be covered for diabetes and other FDA-approved conditions but require new prior authorizations for all patients.
Action Required
By December 31, 2025: All current prior authorizations for GLP-1 drugs expire. Before January 1, 2026: Providers must submit NEW prior authorization requests for ALL patients on GLP-1 medications (semaglutide, tirzepatide, etc.) regardless of indication. Update billing systems to flag that GLP-1 drugs are no longer covered for obesity/weight loss diagnoses. Notify providers that Saxenda is completely discontinued. Claims without new prior auth will be denied starting January 1, 2026.